Conversations with the Pioneers of Oncology: Dr. Allen Lichter - Cancer Stories: The Art of Oncology | Ximalaya International Edition Himalaya (2022)

Conversations with the Pioneers of Oncology: Dr. Allen Lichter

Dr. Hayes interviews Dr. Lichter on his involvement with early breast preservation.

Dr. Daniel F. Hayes is the Stuart B. Padnos Professor of Breast Cancer Research at the University of Michigan Rogel Cancer Center. Dr. Hayes’ research interests are in the field of experimental therapeutics and cancer biomarkers, especially in breast cancer. He has served as chair of the SWOG Breast Cancer Translational Medicine Committee, and he was an inaugural member and chaired the American Society of Clinical Oncology (ASCO) Tumor Marker Guidelines Committee. Dr. Hayes served on the ASCO Board of Directors, and served a 3 year term as President of ASCO from 2016-2018.

The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. 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 an ASCO endorsement.


Welcome to JCO's Cancer Stories-- the Art of Oncology, brought to you by the ASCO podcast network, a collection of nine programs covering a range of educational and scientific content and offering enriching insight into the role of cancer care. You can find all of the shows, including this one, at podcast.asco.org.


Today, my guest on the podcast is Dr. Allen Lichter Dr. Lichter has a long and really storied history in the field of oncology over the last five decades. With his colleagues at the NCI, Drs. David Danforth and Mark Lippman, he was the radiation oncologist PI for one of the four studies that demonstrated that breast preserving therapy was as effective as mastectomy for newly diagnosed breast cancer.


He more or less single-handedly started the Department of Radiation Oncology at the University of Michigan, now considered one of the top programs in the world. He is one of only three radiation oncologists to have been a dean at a major university in the United States, serving as such at the University of Michigan Medical School for eight years.


And he is one of only three radiation oncologists who have been president of ASCO. The others are Sam Hellman, who I've interviewed previously, and our current president, Dr. Lori Pierce, who, by the way, is also from the University of Michigan. And his term was from 1997 to 1999.


Dr. Lichter was born and raised in the Detroit area. He received his undergraduate and his medical degrees at the University of Michigan, after which he completed an internship at a community hospital-- St. Joseph's in Denver-- and then a residency in radiation oncology at the University of California, San Francisco.


Following that, he joined the faculty at Johns Hopkins University, but after two short years there, he moved a few miles south to the National Cancer Institute in 1978, where he was head of the radiation therapy section of the radiation oncology branch. I believe you couldn't have been more than 32 or 33 years old, Allen, at the time. I counted up the years.


He then moved back to Michigan to start the department here, which he chaired for eight years, and then became the dean for eight years. And then he went on to become the Chief Executive Officer of ASCO from 2006 to 2016. In spite of spending the last 20 years of his career as an administrator, Dr. Lichter has authored over 120 peer-reviewed papers. He was the co-editor of Clinical Oncology, one of the major textbooks on oncology, and has really been a leader, especially in radiation oncology, but in cancer in general in this country.


I also want to add he was my boss for eight years when I first moved to University of Michigan, and during which time he was also my next door neighbor here in Ann Arbor. And I got to be his boss for one year-- if anybody could be Allen Lichter's boss-- from my term as ASCO president. Dr. Lichter, welcome to our program.


It's great to be here, Dan.


So a number of questions. I know, first of all, you grew up in Detroit and you went to Cass High School. And while this podcast is supposed to be about the history of oncology, having moved to Ann Arbor, I find the history of Cass High School awfully interesting. Has a number of famous alums, including Diana Ross, Lily Tomlin, Ellen Burstyn, Della Reese, David Alan Grier, Jack White, Alice Coltrane, and-- my guess is, Allen, you don't even know who Big Sean is, but he's a rapper. He's very famous right now for the younger generation.


Any memories from your time there? Did you run into celebrities when you were there? It's quite a place to say you're from, I think.


It's an interesting school, mostly a technical high school, located in downtown Detroit, but with a small college preparatory program that took students from all over the city with a competitive entrance exam. And I don't know what possessed me to get on the Second Avenue bus and ride downtown back and forth every day, but it was a fascinating experience. It takes you out of your normal peer group.


I met young people-- friends-- from all walks of life, from all corners of the city. And it was a pretty rigorous education. I enjoyed it a great deal. And I played on the golf team.


And it sounds to me like you knew you'd be a doctor then. Your father was a family practice doc in a small community just outside of Detroit. Was that true? Did you plan to go to medical school? Or did you have some epiphany when you were at high school?


No, I never remember a single day not wanting to be a physician. My dad was a general practitioner and really instilled in my brother, and in me, a love of science and a love of medicine. My brother went on to be an ophthalmologist and was chair of the department at the University of Michigan for 34 years, President of the American Academy of Ophthalmology. So my dad and my brother set great examples for me, and into medicine I went.


So I have to tell you, my father was a business man and was disappointed that I was in academics because he never understood why I wasn't generating income. My brother went to work for Eli Lilly. He was a doctor, too. And dad always thought he was doing something productive because he worked for Eli Lilly. So I don't know if your dad was disappointed you went to academics instead of family practice, but--


It was interesting. When I started my residency training, I was certainly confident that I would head into private practice and live a life much like my father did. And when I finished training, I decided I just needed a little more buffing up. I figured I'd go into academics for a couple of years, just to make sure I had a good grounding, and then go into private practice. I love the academic life and stayed there my whole career.


I've been fond of asking previous interviewees-- why'd you choose oncology, and specifically radiation oncology, in your case? What led you to go into this path? Especially 40 years ago-- there wasn't a whole lot of oncology to go into.


Well, you know, I was one of those medical students that loved virtually every rotation, and after that rotation I was going to become a fill in the blank. In my senior year of medical school, we were allowed to take an away elective, and I wanted to explore radiology as a potential field. My brother had a very good friend who was a radiation oncologist at the University of California, San Francisco, and the chance in the early 70s to go to San Francisco-- especially avoiding the Michigan winter-- was very compelling.


So I signed up for the electives, and when I got there, I found that it was six weeks of diagnostic radiology and six weeks of radiation oncology. I hadn't expected that, but what the heck. So I did my six weeks of down in the basement looking at teaching sets, which was really quite inspirational. And I went into radiation oncology.


And after my first day, I called my father and I said, I found what I'm going to do. I'm going into radiation oncology. It was instantly fascinating. I love the camaraderie in the department. I love the blend between the physical exams of patients, the treatment of cancer, the use of very high technology equipment and physics. It just struck me and I never wavered from that point on.


So I've heard you talk about this-- and I'm 10 years behind you and even was true when I trained-- was that there wasn't a whole lot of science in radiation oncology back 40 years ago. And the field has evolved. And there are two things-- one you already hit on, which is it was combined with diagnostic radiology. And the second is it split away from diagnostic radiology to become its own field, and a lot of science.


I've spoken with Saul Rosenberg and Sam Hellman and sort of asked them the same question. Give us just a background of the last 40 years of the evolution of radiation oncology because you had a lot to do with that.


Well, of course, the field grew up, as you point out, inside the broad field of radiology. I always would tell my trainees that when Rankin discovered the X-ray, he forgot to discover the instruction manual. So there was a trial and error learning with this very useful technology, but very dangerous technology over a long period of time.


For quite some period of time, you trained in general radiology. You had some time in diagnostic a little time in therapy, and you went out and could do both. But as I entered the field, it was becoming more and more difficult to learn radiation oncology in just the few weeks that they rotated in from their diagnostic duties.


And I was one of the earliest group of trainees who trained in straight radiation oncology-- no diagnostic training, per se. And the field, as you say, split from diagnostic radiology. Had our own boards. I was amongst the earliest group to take the specialty board in radiation oncology.


And the other thing that was true, certainly back in the late 60s and early 70s, is that so much of the field was experiential-- that is, people wrote papers like, you know, the last 100 patients with cancer of the lung that I treated. And this was valuable, but the need to do rigorous, well-controlled clinical trials was obvious to everyone inside the field.


And so the field did become much more scientific. Never quite much as medical oncology, and part of that is because devices are treated differently at the FDA than drugs. Drugs you have to prove through scientific investigation that the agent is safe and effective. And then you can release it for patient use.


For devices, you just have to prove that it basically doesn't kill anybody. And you can get an approval of a device and often get a billing code for the device. So the approval comes, and then you're supposed to do the science.


Well, a lot of people, at that point, they're just too busy using the technology, then, to actually step back and do the science. And, of course, if you spent a lot of money for a piece of technology, to do the science to find out that wasn't a very wise investment is not in your self-interest.


So our science lagged behind. I think it is certainly catching up, but it's still, in fact, in many cases, has a ways to go.


I have enormous respect for our colleagues in the FDA on the devices side, and their hands are tied a bit. But I liken some of what they do to being like underwriter's laboratory. If you plug it in, it doesn't blow up, so they approve it.


Yes. It's a little more than that, but you're right. And so much of the device approvals are based on a predicate of a similar device. And it goes from A to B to C and finally, you know, years down the road, the equipment and its use and its underlying structure is so different from the original device that was approved years ago that you rely on, at every step of the way, it really has-- there's been a lot of scrutiny about changing that, and I think over time it will change.


You know, historically, it's interesting, by what you just said-- some of the first prospective randomized trials in all of medicine were radiation versus nil to the chest wall with breast cancer. To my knowledge, streptomycin versus nil for tuberculosis was the first, but then a whole series of radiation versus nil.


But who would you give credit in the United States-- I would give part credit to you with the work you did with Drs. Lippman and Danforth. Probably one of the first randomized trials in radiation in this country.


Well, you're correct that the first chest wall radiation trial started in Manchester, England in 1948. And at that point, doing randomized trials-- giving some patients the therapy and other patients observing or giving them a placebo-- that was not in widespread use in medicine. And over time, those types of trials began to become more common.


I think in radiation oncology, our big advance was becoming part of the national co-operative group system, where many of the co-operative groups-- maybe all of them-- had a radiation oncology committee. And our studies were often integrated with surgical care or combined modality care with chemotherapy. And so we began a series of very important studies in breast cancer and lung cancer.


The pediatric group did many, many trials that involved plus or minus radiation. I don't know that there's any specific person I'd give credit to, but it was the movement inside the field to join our other oncology colleagues in testing things rather than just doing observational work.


You know, in that regard, let's circle back to your work at the NCI. That must've taken a fair amount of organizational and political skills to mount a breast preserving therapy, just at the NCI. The data that breast preserving therapy was safe was just beginning to be reported. The randomized trials in other places were ongoing. Give us some story there, how the three of you got that going and how you ran that.


Well, of course, virtually everything at the NCI, from a clinical standpoint, is a clinical trial. Patients aren't treated there, just as going to their community hospital. You come to the NCI-- the travel is paid for, the care is paid for, et cetera, based on your agreement to enter into a study.


At the time that I went to the NCI, the NSABP was doing their very large trial of lumpectomy versus mastectomy under Bernie Fisher's direction. My concerns were twofold. Number one-- this was being done at many, many centers around the country, and one could, I think, logically ask the question whether the quality of that care was going to be uniformly high enough to truly test breast preservation therapy. And secondly, I believed-- and many of us believed at the time-- that a boost to the tumor bed was quite important as part of having a low rate of local recurrence, and the NSABP study did not use the boost. They just treated the whole breast and stopped.


And I said, you know, let's do a trial where it's done at a single institution, where the quality is going to be absolutely top notch, where we're going to use a boost and all of the technical tricks that we knew how to do this, just in case the NSABP study didn't come through. We'd have a backup. If both of them were negative, we could forget about lumpectomy and radiation, but if the NSABP was negative, we'd have this.


As it turned out, the NSABP study, as you know, was positive, established for sure the equivalence of preservation therapy, and our study was sort of a little caboose at the end of the train. But that's OK. It confirmed what Ernie and colleagues confirmed very emphatically.


Actually, there's an interesting article in the JCO written by Ian [INAUDIBLE] and his colleagues, about six months ago, that he preluded when he won the award your last year as CEO at ASCO. Was it your award? I can't remember.


Yes.


But anyway-- yeah. And in which, he designated the term I hadn't heard before of statistical fragility. And he made the point that many single prospective randomized trials are positive and the subsequent ones are not. And I give you and, of course, the Italians and the Brits also ran similar trials. It's nice to have four trials that all show the same thing. There's no statistical fragility in this observation.


Yes, well, the NSABP trial was 1,800 patients. Our trial was about 240. We weren't going to change the world, but it was at least comforting to me that we had this trial coming along just in case.


The other academic success that I give you credit for and would love to hear more about it is that you're interested in CT planning, which I think, really, was the forerunner, now, of stereotactic radiation and I would call precision radiation, as opposed to just blasting an organ and hoping you hit the cancer.


And I think, really, a lot of that you brought when you started the department here. But how did you get interested in that?


When I went to the NCI, my first day there, they took me on a tour of the department and we walked by a room with a locked door. I said, what's in there? And they said, oh that's our CT scanner, but we never use it. So I said, well, let me see it.


And, you know, this was an EMI 5005. This was one of the early scanners. It was a body scanner, but it had a fairly small aperture. You could not get a lot of Americans into this machine. And I said, well, why don't we start scanning some patients. As long as-- does anybody know how to use this thing? Yes? OK, let's start scanning some patients.


And it didn't take long to recognize that this was a machine that was almost tailor made to do radiation therapy planning. It gave you the contour of the patient's surface. It showed you the inside of the patient. It showed you the tumor in most settings.


And remember, at that time we were facing radiotherapy treatment planning on plain x-rays taken on the simulator where, for example, when you treated the prostate, you never saw the prostate. You knew where the pubis was. You knew where the rectum was. You knew where the bladder was. And you knew the prostate had to be in there somewhere, but you never saw it.


When we started to CT scan the pelvis in prostate cancer patients, there was the prostate in all its anatomic glory. And so we began to plan on this. And then it became pretty clear that if you took these slices and stacked them back up, like if you took a loaf of bread and it was laying out on the table as individual slices and stacked the slices back up, you could rebuild the three dimensional picture of the loaf.


We decided that that might be a good thing to do with CT scans. And that's when I went to Michigan, and that's when we brought together some terrific physicists and brilliant programmers and spent a lot of money on a roomful of computers and began to do three dimensional reconstruction. And that led to a transformation in radiation therapy from a two dimensional specialty to a three dimensional specialty.


And you could start firing at the tumor from cross sections from different directions. We didn't have to be in the actual plane, et cetera, et cetera, et cetera. And then we put a multi-leaf on the aperture, and so you could shape the field in real time. And it just went from there.


So I have to tell you, when I was a first year fellow at Sidney Farber Cancer Institute, and I saw a patient who had received chest wall radiation-- not at our institution, by the way, not even in Massachusetts. She'd come from one of the other states. And basically, they had just stood her up in front of the machine and turned it on, as far as I could see.


And the amount of normal tissue damage that she had suffered from this was incredible. And I called your friend, Jay Harris, and said, is this what we do here? He said, no way. Had me come down-- he showed me the beginnings of their CT planning and that sort of thing. I didn't know [INAUDIBLE] at the time, but then I learned later, mostly because of your doing.


There were a number of outstanding institutions that were involved in this, and a lot of the inspiration for this came from some of the work that Sam Hellman was writing about, in terms of how we might better use imaging. So it was a team effort across the whole specialty.


By the way, you bring up Dr. Hellman. We just lost Eli Glatstein in the last few months. I'll give you an opportunity to say some nice things about him. I know that you worked with him, and he was a giant in the field.


The reason I was attracted down to the NCI is that this little short pudgy guy, Eli Glatstein, was recruited from Stanford by Vince Devita to come and run the radiation oncology branch. It was a pretty interesting time. There were five of us with Eli. All five of us became department chairs after our time at the NCI.


He was just a phenomenal individual. He gave you a lot of rope. You could either hang yourself, or you could do the work you wanted to do. And we accomplished a lot.


The other thing that I remember-- so I went to the NCI 1978. 1980, Eli said to me-- he handed me a piece of paper. I said, what's this? He says, it's an application form to join ASCO. You need to join ASCO.


So I said, OK. That's not typically what radiation oncologists do, but I'll join. He sponsored me. And then he said, I'm going to see if I can't get you on a committee. And he did. I was on early Grants Award Committee. We handed out five or six young investigator grants.


And I became chair of that committee. And then they said, well, you know, you did a nice job. We're going to put you on another committee, and way led to way. It was entirely because of Eli that I got introduced to ASCO and became such an important part of my life.


He was a giant and will be sorely missed by all of us. And that's a perfect segue into my last question, which is changing gears completely, and that is your career at ASCO. Give us some ideas of what ASCO was like in the late 70s and how it has evolved-- principally, I mean, I know that's a whole hour long discussion, but I think you've had such a huge footprint in the society-- and what you saw changed, and the important changes.


You know, ASCO was founded in 1964. There were no oncologists in 1964. There were doctors who were treating cancer-- some of them with surgery, some of them with radiation, some of them with these very early, highly toxic drugs. And so the society was formed.


And it specifically says, when you read the early writings about this by the founders, that this was not a society of what they called chemotherapeutists. It was a society of physicians who wanted to treat cancer. They brought together all of the clinical specialties.


I like to joke that the most interesting thing is that the medical oncologists forgot to found the American Society of Medical Oncology. They're the only specialty in medicine that doesn't have a specifically focused society just for them. They used ASCO, and to this day, it remains that way.


And so I got involved. And the leaders of ASCO in the 70s and 80s and into the 90s, espousing how wonderful their multidisciplinary work was. And they used to have annual member meetings at the ASCO annual meeting. And the board would sit up on the dais, and the peanut gallery would ask questions.


So I raised my hand, and I walked to the microphone, and I said, you know, it's great how you extol the multidisciplinary nature of the society. But I look at the dais, and I see the 12 members of the board of ASCO, and they're all medical oncologists. You are not practicing what you preach.


And I sat down, and they mumbled a few things. And then the next thing I knew, darn it, they created board slots for a surgeon, a radiation oncologist, and a pediatric oncologist. And then they said, all right, big mouth, now that you held our feet to the fire, we're going to run you for the board. And I did get elected to the board, and then, eventually, got elected president.


And then when they needed a CEO in 2006, they asked me if I was interested, and I interviewed for the job and then moved to Washington and then Alexandria and did that for 10 years. It was really-- you know, I say that I have been involved with two great organizations during my career-- the University of Michigan Medical School, and the American Society of Clinical Oncology. And to have the privilege of leading both of those organizations was just truly amazing.


Well, there are many more things we could talk about, but for our listeners, you should know there's an Allen Lichter Visionary Leadership Award and Lectureship held at every annual meeting now. And for those of you who attend meetings at our headquarters in Alexandria, you'll notice you're sitting in the Allen S. Lichter conference center.


Those weren't done by accident, by the way. They were done because of my guest today and all of the contributions he's made, not just oncology, frankly, but in my opinion, to medicine in general. As a dean, I know many of the things you've done, which we don't have time to get into.


So on behalf of our listeners, and behalf of myself, and behalf of all the patients who have benefited through your work through the years, thanks so much, Allen. [INAUDIBLE]


Dan, it was great being with you. Thanks for talking to me.


Until next time, thank you for listening to this JCO's Cancer Stories-- The Art of Oncology podcast. If you enjoyed what you heard today, don't forget to give us a rating or review on Apple Podcasts, or wherever you listen. While you're there, be sure to subscribe so you never miss an episode. JCO's Cancer Stories-- The Art of Oncology podcast is just one of ASCO's many podcasts. You can find all the shows at podcast.asco.org.

Dr. Hayes interviews Dr. Lichter on his involvement with early breast preservation. Dr. Daniel F. Hayes is the Stuart B. Padnos Professor of Breast Cancer Research at the University of Michigan Rogel Cancer Center. Dr. Hayes’ research interests are in the field of experimental therapeutics and cancer biomarkers, especially in breast cancer. He has served as chair of the SWOG Breast Cancer Translational Medicine Committee, and he was an inaugural member and chaired the American Society of Clinical Oncology (ASCO) Tumor Marker Guidelines Committee. Dr. Hayes served on the ASCO Board of Directors, and served a 3 year term as President of ASCO from 2016-2018.   The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. 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 an ASCO endorsement. Welcome to JCO's Cancer Stories-- the Art of Oncology, brought to you by the ASCO podcast network, a collection of nine programs covering a range of educational and scientific content and offering enriching insight into the role of cancer care. You can find all of the shows, including this one, at podcast.asco.org. Today, my guest on the podcast is Dr. Allen Lichter Dr. Lichter has a long and really storied history in the field of oncology over the last five decades. With his colleagues at the NCI, Drs. David Danforth and Mark Lippman, he was the radiation oncologist PI for one of the four studies that demonstrated that breast preserving therapy was as effective as mastectomy for newly diagnosed breast cancer. He more or less single-handedly started the Department of Radiation Oncology at the University of Michigan, now considered one of the top programs in the world. He is one of only three radiation oncologists to have been a dean at a major university in the United States, serving as such at the University of Michigan Medical School for eight years. And he is one of only three radiation oncologists who have been president of ASCO. The others are Sam Hellman, who I've interviewed previously, and our current president, Dr. Lori Pierce, who, by the way, is also from the University of Michigan. And his term was from 1997 to 1999. Dr. Lichter was born and raised in the Detroit area. He received his undergraduate and his medical degrees at the University of Michigan, after which he completed an internship at a community hospital-- St. Joseph's in Denver-- and then a residency in radiation oncology at the University of California, San Francisco. Following that, he joined the faculty at Johns Hopkins University, but after two short years there, he moved a few miles south to the National Cancer Institute in 1978, where he was head of the radiation therapy section of the radiation oncology branch. I believe you couldn't have been more than 32 or 33 years old, Allen, at the time. I counted up the years. He then moved back to Michigan to start the department here, which he chaired for eight years, and then became the dean for eight years. And then he went on to become the Chief Executive Officer of ASCO from 2006 to 2016. In spite of spending the last 20 years of his career as an administrator, Dr. Lichter has authored over 120 peer-reviewed papers. He was the co-editor of Clinical Oncology, one of the major textbooks on oncology, and has really been a leader, especially in radiation oncology, but in cancer in general in this country. I also want to add he was my boss for eight years when I first moved to University of Michigan, and during which time he was also my next door neighbor here in Ann Arbor. And I got to be his boss for one year-- if anybody could be Allen Lichter's boss-- from my term as ASCO president. Dr. Lichter, welcome to our program. It's great to be here, Dan. So a number of questions. I know, first of all, you grew up in Detroit and you went to Cass High School. And while this podcast is supposed to be about the history of oncology, having moved to Ann Arbor, I find the history of Cass High School awfully interesting. Has a number of famous alums, including Diana Ross, Lily Tomlin, Ellen Burstyn, Della Reese, David Alan Grier, Jack White, Alice Coltrane, and-- my guess is, Allen, you don't even know who Big Sean is, but he's a rapper. He's very famous right now for the younger generation. Any memories from your time there? Did you run into celebrities when you were there? It's quite a place to say you're from, I think. It's an interesting school, mostly a technical high school, located in downtown Detroit, but with a small college preparatory program that took students from all over the city with a competitive entrance exam. And I don't know what possessed me to get on the Second Avenue bus and ride downtown back and forth every day, but it was a fascinating experience. It takes you out of your normal peer group. I met young people-- friends-- from all walks of life, from all corners of the city. And it was a pretty rigorous education. I enjoyed it a great deal. And I played on the golf team. And it sounds to me like you knew you'd be a doctor then. Your father was a family practice doc in a small community just outside of Detroit. Was that true? Did you plan to go to medical school? Or did you have some epiphany when you were at high school? No, I never remember a single day not wanting to be a physician. My dad was a general practitioner and really instilled in my brother, and in me, a love of science and a love of medicine. My brother went on to be an ophthalmologist and was chair of the department at the University of Michigan for 34 years, President of the American Academy of Ophthalmology. So my dad and my brother set great examples for me, and into medicine I went. So I have to tell you, my father was a business man and was disappointed that I was in academics because he never understood why I wasn't generating income. My brother went to work for Eli Lilly. He was a doctor, too. And dad always thought he was doing something productive because he worked for Eli Lilly. So I don't know if your dad was disappointed you went to academics instead of family practice, but-- It was interesting. When I started my residency training, I was certainly confident that I would head into private practice and live a life much like my father did. And when I finished training, I decided I just needed a little more buffing up. I figured I'd go into academics for a couple of years, just to make sure I had a good grounding, and then go into private practice. I love the academic life and stayed there my whole career. I've been fond of asking previous interviewees-- why'd you choose oncology, and specifically radiation oncology, in your case? What led you to go into this path? Especially 40 years ago-- there wasn't a whole lot of oncology to go into. Well, you know, I was one of those medical students that loved virtually every rotation, and after that rotation I was going to become a fill in the blank. In my senior year of medical school, we were allowed to take an away elective, and I wanted to explore radiology as a potential field. My brother had a very good friend who was a radiation oncologist at the University of California, San Francisco, and the chance in the early 70s to go to San Francisco-- especially avoiding the Michigan winter-- was very compelling. So I signed up for the electives, and when I got there, I found that it was six weeks of diagnostic radiology and six weeks of radiation oncology. I hadn't expected that, but what the heck. So I did my six weeks of down in the basement looking at teaching sets, which was really quite inspirational. And I went into radiation oncology. And after my first day, I called my father and I said, I found what I'm going to do. I'm going into radiation oncology. It was instantly fascinating. I love the camaraderie in the department. I love the blend between the physical exams of patients, the treatment of cancer, the use of very high technology equipment and physics. It just struck me and I never wavered from that point on. So I've heard you talk about this-- and I'm 10 years behind you and even was true when I trained-- was that there wasn't a whole lot of science in radiation oncology back 40 years ago. And the field has evolved. And there are two things-- one you already hit on, which is it was combined with diagnostic radiology. And the second is it split away from diagnostic radiology to become its own field, and a lot of science. I've spoken with Saul Rosenberg and Sam Hellman and sort of asked them the same question. Give us just a background of the last 40 years of the evolution of radiation oncology because you had a lot to do with that. Well, of course, the field grew up, as you point out, inside the broad field of radiology. I always would tell my trainees that when Rankin discovered the X-ray, he forgot to discover the instruction manual. So there was a trial and error learning with this very useful technology, but very dangerous technology over a long period of time. For quite some period of time, you trained in general radiology. You had some time in diagnostic a little time in therapy, and you went out and could do both. But as I entered the field, it was becoming more and more difficult to learn radiation oncology in just the few weeks that they rotated in from their diagnostic duties. And I was one of the earliest group of trainees who trained in straight radiation oncology-- no diagnostic training, per se. And the field, as you say, split from diagnostic radiology. Had our own boards. I was amongst the earliest group to take the specialty board in radiation oncology. And the other thing that was true, certainly back in the late 60s and early 70s, is that so much of the field was experiential-- that is, people wrote papers like, you know, the last 100 patients with cancer of the lung that I treated. And this was valuable, but the need to do rigorous, well-controlled clinical trials was obvious to everyone inside the field. And so the field did become much more scientific. Never quite much as medical oncology, and part of that is because devices are treated differently at the FDA than drugs. Drugs you have to prove through scientific investigation that the agent is safe and effective. And then you can release it for patient use. For devices, you just have to prove that it basically doesn't kill anybody. And you can get an approval of a device and often get a billing code for the device. So the approval comes, and then you're supposed to do the science. Well, a lot of people, at that point, they're just too busy using the technology, then, to actually step back and do the science. And, of course, if you spent a lot of money for a piece of technology, to do the science to find out that wasn't a very wise investment is not in your self-interest. So our science lagged behind. I think it is certainly catching up, but it's still, in fact, in many cases, has a ways to go. I have enormous respect for our colleagues in the FDA on the devices side, and their hands are tied a bit. But I liken some of what they do to being like underwriter's laboratory. If you plug it in, it doesn't blow up, so they approve it. Yes. It's a little more than that, but you're right. And so much of the device approvals are based on a predicate of a similar device. And it goes from A to B to C and finally, you know, years down the road, the equipment and its use and its underlying structure is so different from the original device that was approved years ago that you rely on, at every step of the way, it really has-- there's been a lot of scrutiny about changing that, and I think over time it will change. You know, historically, it's interesting, by what you just said-- some of the first prospective randomized trials in all of medicine were radiation versus nil to the chest wall with breast cancer. To my knowledge, streptomycin versus nil for tuberculosis was the first, but then a whole series of radiation versus nil. But who would you give credit in the United States-- I would give part credit to you with the work you did with Drs. Lippman and Danforth. Probably one of the first randomized trials in radiation in this country. Well, you're correct that the first chest wall radiation trial started in Manchester, England in 1948. And at that point, doing randomized trials-- giving some patients the therapy and other patients observing or giving them a placebo-- that was not in widespread use in medicine. And over time, those types of trials began to become more common. I think in radiation oncology, our big advance was becoming part of the national co-operative group system, where many of the co-operative groups-- maybe all of them-- had a radiation oncology committee. And our studies were often integrated with surgical care or combined modality care with chemotherapy. And so we began a series of very important studies in breast cancer and lung cancer. The pediatric group did many, many trials that involved plus or minus radiation. I don't know that there's any specific person I'd give credit to, but it was the movement inside the field to join our other oncology colleagues in testing things rather than just doing observational work. You know, in that regard, let's circle back to your work at the NCI. That must've taken a fair amount of organizational and political skills to mount a breast preserving therapy, just at the NCI. The data that breast preserving therapy was safe was just beginning to be reported. The randomized trials in other places were ongoing. Give us some story there, how the three of you got that going and how you ran that. Well, of course, virtually everything at the NCI, from a clinical standpoint, is a clinical trial. Patients aren't treated there, just as going to their community hospital. You come to the NCI-- the travel is paid for, the care is paid for, et cetera, based on your agreement to enter into a study. At the time that I went to the NCI, the NSABP was doing their very large trial of lumpectomy versus mastectomy under Bernie Fisher's direction. My concerns were twofold. Number one-- this was being done at many, many centers around the country, and one could, I think, logically ask the question whether the quality of that care was going to be uniformly high enough to truly test breast preservation therapy. And secondly, I believed-- and many of us believed at the time-- that a boost to the tumor bed was quite important as part of having a low rate of local recurrence, and the NSABP study did not use the boost. They just treated the whole breast and stopped. And I said, you know, let's do a trial where it's done at a single institution, where the quality is going to be absolutely top notch, where we're going to use a boost and all of the technical tricks that we knew how to do this, just in case the NSABP study didn't come through. We'd have a backup. If both of them were negative, we could forget about lumpectomy and radiation, but if the NSABP was negative, we'd have this. As it turned out, the NSABP study, as you know, was positive, established for sure the equivalence of preservation therapy, and our study was sort of a little caboose at the end of the train. But that's OK. It confirmed what Ernie and colleagues confirmed very emphatically. Actually, there's an interesting article in the JCO written by Ian [INAUDIBLE] and his colleagues, about six months ago, that he preluded when he won the award your last year as CEO at ASCO. Was it your award? I can't remember. Yes. But anyway-- yeah. And in which, he designated the term I hadn't heard before of statistical fragility. And he made the point that many single prospective randomized trials are positive and the subsequent ones are not. And I give you and, of course, the Italians and the Brits also ran similar trials. It's nice to have four trials that all show the same thing. There's no statistical fragility in this observation. Yes, well, the NSABP trial was 1,800 patients. Our trial was about 240. We weren't going to change the world, but it was at least comforting to me that we had this trial coming along just in case. The other academic success that I give you credit for and would love to hear more about it is that you're interested in CT planning, which I think, really, was the forerunner, now, of stereotactic radiation and I would call precision radiation, as opposed to just blasting an organ and hoping you hit the cancer. And I think, really, a lot of that you brought when you started the department here. But how did you get interested in that? When I went to the NCI, my first day there, they took me on a tour of the department and we walked by a room with a locked door. I said, what's in there? And they said, oh that's our CT scanner, but we never use it. So I said, well, let me see it. And, you know, this was an EMI 5005. This was one of the early scanners. It was a body scanner, but it had a fairly small aperture. You could not get a lot of Americans into this machine. And I said, well, why don't we start scanning some patients. As long as-- does anybody know how to use this thing? Yes? OK, let's start scanning some patients. And it didn't take long to recognize that this was a machine that was almost tailor made to do radiation therapy planning. It gave you the contour of the patient's surface. It showed you the inside of the patient. It showed you the tumor in most settings. And remember, at that time we were facing radiotherapy treatment planning on plain x-rays taken on the simulator where, for example, when you treated the prostate, you never saw the prostate. You knew where the pubis was. You knew where the rectum was. You knew where the bladder was. And you knew the prostate had to be in there somewhere, but you never saw it. When we started to CT scan the pelvis in prostate cancer patients, there was the prostate in all its anatomic glory. And so we began to plan on this. And then it became pretty clear that if you took these slices and stacked them back up, like if you took a loaf of bread and it was laying out on the table as individual slices and stacked the slices back up, you could rebuild the three dimensional picture of the loaf. We decided that that might be a good thing to do with CT scans. And that's when I went to Michigan, and that's when we brought together some terrific physicists and brilliant programmers and spent a lot of money on a roomful of computers and began to do three dimensional reconstruction. And that led to a transformation in radiation therapy from a two dimensional specialty to a three dimensional specialty. And you could start firing at the tumor from cross sections from different directions. We didn't have to be in the actual plane, et cetera, et cetera, et cetera. And then we put a multi-leaf on the aperture, and so you could shape the field in real time. And it just went from there. So I have to tell you, when I was a first year fellow at Sidney Farber Cancer Institute, and I saw a patient who had received chest wall radiation-- not at our institution, by the way, not even in Massachusetts. She'd come from one of the other states. And basically, they had just stood her up in front of the machine and turned it on, as far as I could see. And the amount of normal tissue damage that she had suffered from this was incredible. And I called your friend, Jay Harris, and said, is this what we do here? He said, no way. Had me come down-- he showed me the beginnings of their CT planning and that sort of thing. I didn't know [INAUDIBLE] at the time, but then I learned later, mostly because of your doing. There were a number of outstanding institutions that were involved in this, and a lot of the inspiration for this came from some of the work that Sam Hellman was writing about, in terms of how we might better use imaging. So it was a team effort across the whole specialty. By the way, you bring up Dr. Hellman. We just lost Eli Glatstein in the last few months. I'll give you an opportunity to say some nice things about him. I know that you worked with him, and he was a giant in the field. The reason I was attracted down to the NCI is that this little short pudgy guy, Eli Glatstein, was recruited from Stanford by Vince Devita to come and run the radiation oncology branch. It was a pretty interesting time. There were five of us with Eli. All five of us became department chairs after our time at the NCI. He was just a phenomenal individual. He gave you a lot of rope. You could either hang yourself, or you could do the work you wanted to do. And we accomplished a lot. The other thing that I remember-- so I went to the NCI 1978. 1980, Eli said to me-- he handed me a piece of paper. I said, what's this? He says, it's an application form to join ASCO. You need to join ASCO. So I said, OK. That's not typically what radiation oncologists do, but I'll join. He sponsored me. And then he said, I'm going to see if I can't get you on a committee. And he did. I was on early Grants Award Committee. We handed out five or six young investigator grants. And I became chair of that committee. And then they said, well, you know, you did a nice job. We're going to put you on another committee, and way led to way. It was entirely because of Eli that I got introduced to ASCO and became such an important part of my life. He was a giant and will be sorely missed by all of us. And that's a perfect segue into my last question, which is changing gears completely, and that is your career at ASCO. Give us some ideas of what ASCO was like in the late 70s and how it has evolved-- principally, I mean, I know that's a whole hour long discussion, but I think you've had such a huge footprint in the society-- and what you saw changed, and the important changes. You know, ASCO was founded in 1964. There were no oncologists in 1964. There were doctors who were treating cancer-- some of them with surgery, some of them with radiation, some of them with these very early, highly toxic drugs. And so the society was formed. And it specifically says, when you read the early writings about this by the founders, that this was not a society of what they called chemotherapeutists. It was a society of physicians who wanted to treat cancer. They brought together all of the clinical specialties. I like to joke that the most interesting thing is that the medical oncologists forgot to found the American Society of Medical Oncology. They're the only specialty in medicine that doesn't have a specifically focused society just for them. They used ASCO, and to this day, it remains that way. And so I got involved. And the leaders of ASCO in the 70s and 80s and into the 90s, espousing how wonderful their multidisciplinary work was. And they used to have annual member meetings at the ASCO annual meeting. And the board would sit up on the dais, and the peanut gallery would ask questions. So I raised my hand, and I walked to the microphone, and I said, you know, it's great how you extol the multidisciplinary nature of the society. But I look at the dais, and I see the 12 members of the board of ASCO, and they're all medical oncologists. You are not practicing what you preach. And I sat down, and they mumbled a few things. And then the next thing I knew, darn it, they created board slots for a surgeon, a radiation oncologist, and a pediatric oncologist. And then they said, all right, big mouth, now that you held our feet to the fire, we're going to run you for the board. And I did get elected to the board, and then, eventually, got elected president. And then when they needed a CEO in 2006, they asked me if I was interested, and I interviewed for the job and then moved to Washington and then Alexandria and did that for 10 years. It was really-- you know, I say that I have been involved with two great organizations during my career-- the University of Michigan Medical School, and the American Society of Clinical Oncology. And to have the privilege of leading both of those organizations was just truly amazing. Well, there are many more things we could talk about, but for our listeners, you should know there's an Allen Lichter Visionary Leadership Award and Lectureship held at every annual meeting now. And for those of you who attend meetings at our headquarters in Alexandria, you'll notice you're sitting in the Allen S. Lichter conference center. Those weren't done by accident, by the way. They were done because of my guest today and all of the contributions he's made, not just oncology, frankly, but in my opinion, to medicine in general. As a dean, I know many of the things you've done, which we don't have time to get into. So on behalf of our listeners, and behalf of myself, and behalf of all the patients who have benefited through your work through the years, thanks so much, Allen. [INAUDIBLE] Dan, it was great being with you. Thanks for talking to me. Until next time, thank you for listening to this JCO's Cancer Stories-- The Art of Oncology podcast. If you enjoyed what you heard today, don't forget to give us a rating or review on Apple Podcasts, or wherever you listen. While you're there, be sure to subscribe so you never miss an episode. JCO's Cancer Stories-- The Art of Oncology podcast is just one of ASCO's many podcasts. You can find all the shows at podcast.asco.org.

He is one of only three radiation. oncologists to have been a dean at a major university in the United. States, serving as such at the University of Michigan Medical. School for eight years.. I. believe you couldn't have been more than 32 or 33 years old, Allen,. at the time.. And I went into radiation. oncology.. I'm going into radiation oncology.. So I've heard you talk about this-- and I'm 10 years behind you and. even was true when I trained-- was that there wasn't a whole lot of. science in radiation oncology back 40 years ago.. You had some time in diagnostic a little time in therapy, and you. went out and could do both.. Yes, well, the NSABP trial was 1,800 patients.. There were a number of outstanding institutions that were involved. in this, and a lot of the inspiration for this came from some of. the work that Sam Hellman was writing about, in terms of how we. might better use imaging.. I like to joke that the most interesting thing is that the medical. oncologists forgot to found the American Society of Medical. Oncology.. It was. really-- you know, I say that I have been involved with two great. organizations during my career-- the University of Michigan Medical. School, and the American Society of Clinical Oncology.. Well, there are many more things we could talk about, but for our. listeners, you should know there's an Allen Lichter Visionary. Leadership Award and Lectureship held at every annual meeting now.. As a. dean, I know many of the things you've done, which we don't have. time to get into.

Dr. Hayes interviews Dr. Allen Lichter for a second time on ASCO. Dr. Daniel F. Hayes is the Stuart B. Padnos Professor of Breast Cancer Research at the University of Michigan Rogel Cancer Center. Dr. Hayes’ research interests are in the field of experimental therapeutics and cancer biomarkers, especially in breast cancer. He has served as chair of the SWOG Breast Cancer Translational Medicine Committee, and he was an inaugural member and chaired the American Society of Clinical Oncology (ASCO) Tumor Marker Guidelines Committee. Dr. Hayes served on the ASCO Board of Directors, and served a 3 year term as President of ASCO from 2016-2018. TRANSCRIPT SPEAKER: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. 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 an ASCO endorsement. [MUSIC PLAYING]   DANIEL F. HAYES: Welcome to JCO's Cancer Stories-- The Art of Oncology, brought to you by the ASCO Podcast Network, a collection of nine programs covering a range of educational and scientific content and offering enriching insights into the world of cancer care. You can find all of the shows, including this one, at a podcast.asco.org. Today, our guest is Dr. Allen Lichter, the former CEO of the American Society of Clinical Oncology. Dr. Lichter has previously been a guest on this program in regards to his role as a radiation oncologist back in the early days and the research he did. But today, I'm going to ask him more about the history of ASCO. To begin with, Dr. Lichter has leadership roles with Cellworks and Lifelike. He has a consulting or advisory role with Integra, Ascentage Pharma, L-Nutra, and TRG Healthcare. He's also received travel 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 time we spoke, I really was focused on having you tell us about the evolution of radio psychology in this country, and was a terrific interview. 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 a president of ASCO, you've been a CEO of ASCO, you're pretty much done it all, I thought we'd take an opportunity to pick your brain about the history of ASCO. So to start with, I think a lot of our listeners probably don't know much about how ASCO got started in the first place. You want to 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 1940s and '50s, a few chemotherapy agents were invented and brought into practice. Toxicity was high. The benefits weren't that great. But there was some hope that through scientific discovery and research, things could get better. In 1954, the NCI created the first National Drug Discovery program, which began to catalyze the discovery of more chemotherapy agents. And it's into that environment that a group of, who were then internal medicine docs, started to use chemotherapy more and began creating some training programs in medical oncology. That led in the early '60s to an organizing meeting that took place 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 and formed an organization concerned with the management, the clinical management, of cancer. And you go back to that early meeting and read the following sentence, quote, "This society shall not be a society of chemotherapeuticsts only. The society should consider the total management of cancer." They established dues of $10 a year, and they agreed to meet again at the following spring. And on April 10, 1965, at the next AACR meeting-- or, actually, the original meeting was off cycle from AACR. And then, in '65, they met formally at AACR for the first time. That sentence, that this is not a society of chemotherapeuticsts, as they wrote it-- because there were no medical oncologists-- but was a society for cancer physicians of all persuasions, was a fundamental organizing principle of ASCO, a principle that holds true today. And it is one of the great strengths of ASCO, is that it welcomes and embraces and enjoys the membership of oncologists of all subspecialties. And then, as you move ahead in the development of medical oncology, you get to the American Board of Internal Medicine that had pressure from outside agitators, people like PJ Kennedy and Paul Calabrese and Paul Carbone, and Jim Holland and Tom Frei and Al Owens, to form and create a subspecialty board in this nascent specialty of medical oncology. And that came into fruition in the early 1970s. And if you go back into the '70s, ASCO had a revenue of $25,000. That was the annual revenue of the organization. It's now probably close to $150 million. And ASCO is number two in terms of the size of its revenue of all medical professional societies in the US behind only the American Medical Association. So that first idea of founding the society, creating it as a multidisciplinary society, and standing back and watching it grow as the specialties in oncology grew, has really borne fruit over many, many years. There were seven founders of the organization. Their names are in the ASCO office. People who come to the ASCO office can come into our big boardroom, which is called the Founder'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 only female in this group at the time, one of the few African-American medical oncologists in the nation. She had a distinguished career and has had many awards and tributes given to her both by ASCO and by AACR. So the society moved along. And I like to say to people, you know, what is really startling is that the field of medical oncology, the medical oncologists forgot to establish the American Society of Medical Oncology. They are, to this day, the only medical subspecialty in internal medicine that does not have its own dedicated professional society. ASCO has filled that role from its inception through the time that the specialty boards were created. And to this day, there is no ESMO, there is only ASCO. And so ASCO has this dual organizational responsibility, one to the entire field of oncology, and then a very special relationship with the field of medical oncology, as we represent that specialty almost exclusively. DANIEL F. HAYES: Let me jump in. There, for example, is a Society of Surgical Oncology and the American Society of Therapeutic Radiation Oncology, which I believe you were president of as well. So I agree with you that the internal medicine part of it is really unique in terms of ASCO serving as a society for everybody, even though there are these other societies that represent the individual modalities. ALLEN LICHTER: Yes. There is nothing quite like it. It has worked well. We have never, to my knowledge, had an uprising of the medical 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 attention to those special needs of community practice in oncology. But even then, virtually all the members of COA are members of ASCO as well. So as the society moved along and it grew beyond its $25,000 revenue, we hired a professional management firm to run the administration of the society, a firm called Bostrom. They were based out of Chicago. And for many years, a guy named Al Van Horn was 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 with ASCO until we got into the early 1990s. I was on the board at that time, but I'll digress for a moment to talk about how I got on the board. So at the annual meeting of ASCO, they always had a member's meeting. And it was like at 4 o'clock in the afternoon. And it was in one of the meeting rooms. And the dais was set with a long table. And the board of directors sat at the table. And the membership who, those that came, sat in the audience and heard from the leaders of the organization what was going on, et cetera, et cetera. And then, they had open mic that members could come forward and ask questions. So I arose from my seat and went to the microphone. And I said, gentlemen-- because they were all men-- you have extolled the multidisciplinary nature of this organization that existed from its founding up to the present day. But as I look at the assembled board in front of me, they are 100% medical oncologists. And you have radiation oncologists and surgical oncologists and pediatric oncologists and gynecologic oncologists and so forth in the organization. And we have no representation on the board. And they said, thank you, Dr. Lichter, for your question. And down I sat. But a little seed was planted, I guess. Because over the next couple years, the board decided to enlarge its membership and have dedicated seats for a radiation oncologist, a surgical oncologist, and a pediatric oncologist, seats that exist today. And I 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 got elected to the board as the first radiation-- sitting in the first radiation oncology seat. I watched as the society grew. And we recognized, we needed to take over our own management, to move away from the hired hands at Bostrom and to have our own organization. And it was under the steady hand of then President John Glick, who led us through this transition. We interviewed candidates to be the then called the executive vice president and hired John Durant, who was then at the University of Alabama. And John took us through that transition. We opened an office in Alexandria, Virginia, and began to hire staff. And John was an absolutely sensational leader for the organization during that important transition. And that was in kind of the mid '90s. John Glick was one of the truly terrific presidents of ASCO. And I contributed to that because I ran against John. And John wanted an election. And it was my doing that John became president of ASCO. I graciously lost to him. They decided, for some reason or another, that they would run me again for president. And I did win that election. I ran against Charles Balch, who was a surgeon. And Charles later succeeded John Durant as the CEO of ASCO as ASCO's second CEO. I was president '98-'99 was my year. And the organization continued to grow. I rotated off the board and was happily in my job at Ann Arbor. And then, Dr. Balch was stepping down and they were looking for a CEO. And I threw my hat in the ring and became the CEO of the organization in 2006. And that's a big, broad overview of the organization. It now has 45,000 members, as I say, a wonderful and steady revenue stream, although it's been a challenge over the last 18 months with COVID and losing the physical annual meeting. But those 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 the original meeting. And they were pretty interested in how do you dose 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, ASCO was principally a place to present your data and publish your papers in JCO. By that time, personally, I feel that it began to roll back into saying, look, 60% to 70% of our members are community oncologists. And I've seen a huge increase in ASCO's focus on the community oncologist. Is that perception all true, or am I making it up? ALLEN LICHTER: I think that that's true. If you look back at the first annual meeting in 1965, I think there were three or four papers presented. They were all clinical, and in some respects, as they should be. Because people wanted to begin to share their experience with using these new highly toxic agents. There was just no precedent. Everything was done through trial and error and clinical research and experimentation. And so the results were shared. And the society continued along in that vein not so much as a pure scientific society, and certainly, not so much as presenting basic science research, but presenting clinical research. I think at the time, it was felt that the more pure science was AACR. And ASCO was going to present the clinical stuff. And as you know, for the first many, many years of the society, the two societies met back-to-back. So a typical meeting in the 1980s was Monday and Tuesday was AACR. Wednesday was an overlap day, and then Thursday and Friday was ASCO. And so that dichotomy of, there is the science, especially the bed science, and there's the clinical science at the end of the week, existed for quite some time until ASCO grew its meeting enough, worked out an arrangement with AACR, and the two meetings divided, with AACR meeting in April and ASCO meeting in June-- again, something that still exists to this day. DANIEL F. HAYES: When you were CEO, though, for example, you initiated the Department of Clinical Affairs or something to that effect. 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 about that. ALLEN LICHTER: Over the years, not only did ASCO develop as a national organization, but within each state, either a medical oncology or an oncology writ large society was formed. And just about every state had them. It was not a revolutionary idea to begin to try to tie the affiliates into ASCO. Not that were floundering in any way, but they could use some support speakers to be arranged for their own annual gatherings. And we became much more interested in making sure there was a dialogue between ASCO central and what was going on in the trenches of physician practice in the community and around the states. And so we began to bring the state affiliates closer to the organization. A lot of this was done under the guidance of Joe Bailes, who was president of ASCO after me and had a prominent role in the government relations aspects of reimbursement aspects of the specialty. And Joe was very close to the state affiliates. That grew in importance and we ended up creating the state affiliate council and hearing from them at each board meeting and then finally, to the point where we had the president of the state affiliate 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. Medical oncology really, in essence, grew up as an academic discipline. It was started at major medical centers like Sloan Kettering and MD Anderson and so forth. You might be too young to remember, but patients used to be admitted to hospital to receive their chemotherapy. And they certainly were admitted, often admitted to hospital to receive their radiation to some extent, because insurance wouldn't pay for it if it was given-- and there was no such thing as outpatient cancer therapy. But as the specialty then began to move out of these large academic hospitals and into the community, that began this whole infrastructure of state affiliate societies and our relationship up and down. We are not just an organization of academics, although we've been led mostly by academic physicians throughout our history. The community oncologists have a very important role to play not only in ASCO, but in the delivery of cancer care in this country. DANIEL F. HAYES: Actually, I am old enough. I remember I told many fellows that when I was a fellow, we put people in the hospital. All we had was prochlorperazine, Compazine, which doesn't work at all. And we would give them barbiturates not because it kept them from throwing up, but it kept them from remembering how much they threw up so they would come back and get their next treatment. So it was pretty barbaric. Now, all outpatient, which is fantastic. Actually, you touched on this briefly, but how about the evolution of ASCO as an advocacy organization in politics, which has taken a major step lately? ALLEN LICHTER: Even while we were under the management of Bostrom, we did have a legislative government relations team in Washington. And the first couple of fulltime employees that ASCO had were hired in the government relations side. And a lot of this was really, again, we had to represent medical oncology in important areas of billing and reimbursements and Medicare coverage and 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 represent medical 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 the complexity of Medicare and Medicaid and private insurance, and the cost of care and inpatients and outpatients, and who's going to pay for what, where, and so on, and so forth, we have become deeply enmeshed in that. Because, again, it's our responsibility to do so. And I think the society over the years has done an excellent job of representing this field. DANIEL F. HAYES: Even to the extent that recently, we've set up a 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 Clinical Oncology. Anyway, it's named so that it can also be called ASCO. But when ASCO was founded-- and this makes us different from a lot of our sister societies-- we were founded as a 501(c)(3). That's the tax code, educational organization. And as a 501(c)(3) educational organization, we could not engage very much in what is known as lobbying. We could advocate for legislation. We could do some gentle advocation for legislation. We could interface with regulatory agencies. So we were unlimited in our ability to talk to the FDA or the CDC or the Centers for Medicare and Medicaid and that. But we couldn't do very much on the legislative side. And we thought for a long time about whether that needed to be remedied or not. In the end, it was decided it did need to be remedied. That is, we needed to have the ability to have a bigger footprint inside Capitol Hill in the legislative process. Virtually, all our sister societies had that. And many of them were founded 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 for Clinical Oncology, that allows us to have a more visible presence on the legislative side of the house and the ability to influence legislation on behalf of cancer patients and cancer physicians. DANIEL F. HAYES: Yeah, I think most of our membership, probably especially the academics, have always just thought, well, I don't have to worry about this. ASCO has my back. And what I have seen in the last 10 years is, first of all, an increasing presence of ASCO on 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 even when I got elected, I think there were 40 of us that did this. I had never done it before. It was a lot of fun, where we go out and meet with the senators and representatives and their staff, and with specific issues that we think are important for our patients. We just did this virtually last week. And I think there were 130 of us or something. That's increased quite a bit. And those discussions are now being led by what is essentially a PAC, a political action committee, this association but with a lot more influence that has had in the past. And I know I sound like I'm on a soapbox, but I've become a true believer, maintaining what you and your predecessors continued to emphasize, which is that we are not a trade union. We are there to improve patient care. And that's what we do. The topics we choose to discuss are related to things we feel need 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 ASCO who's done this. ALLEN LICHTER: Yes. And with the political action committee, it does give us the chance to have a presence at certain events that before, we couldn't, we could not have a presence then. It allows us to have influence as we can support those legislators that are sympathetic to the work that we're trying to get accomplished, and so on, and so forth. We resisted it for so long, it was time and the appropriate thing to do. And I join you in being proud of the organization to have just done it. DANIEL F. HAYES: So that's an advertisement. If any of our listeners would like to become part of the day's on the Hill, if you go into the volunteer corps, you can sign up and ASCP staff will 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's actually a lot of fun to do. And this association has very real guardrails set up so that we continue to advocate and lobby, again, for what we think is best for our patients. And that's another reason I was very supportive of it when it came around. ALLEN LICHTER: Your mentioning of volunteers makes me want to comment. Many of our sister societies, when I was CEO, the organizations that got together a couple of times a year were saying how difficult it was to get members to participate in the work of the society. Everybody was so busy in their practice environment, or their academic environment, or whatever. ASCO has always had exactly the opposite problem. We have way more of our dedicated members who want to participate in the society than we have places for them to participate. So it's a wonderful problem to have. It has been that way for as long as I can remember, and continues that way today. It's a real tribute, I think, to the specialty as to how dedicated our members are in being willing to volunteer and serve, and really devoting a huge amount of time. You've been president. You've been on the board. That service is all volunteer and takes, over a career, hundreds and hundreds and hundreds of hours. But people do it actively and willingly. And our only problem is I wish we had more spots for people to have positions inside the organization. DANIEL F. HAYES: When I became president, I think I had 220 slots, or something like that, to fill. And I had something like 2,000 people volunteer. And I agree with you. Actually, was it under your watch that the designated seats for community oncologists for the board became a reality? Or was that before you? ALLEN LICHTER: That existed before. That was added. And I can't remember if it was added at the time the subspecialists were added or whether it came a separate thing. But yes, and it goes to what we were talking about before, which is with community oncologists, we felt very important even as today, that they needed a seat at the table for ASCO. So we have this dedicated seat for a community oncologist, and even have brought community people into the undesignated seats. We learn a lot from our community colleagues and need them and have them close at hand. DANIEL F. HAYES: I have said many, many times before I was on the board and when I was president that the academics, including myself, will speak up to show you how smart they are. But the community oncologists on the board were there for a very real reason. And I learned very quickly my first year on the board, keep my mouth shut and listen to these folks because they had a lot to tell us. They're there because they want to make things well. I think the academics are too. They want to make things better. But the community oncologists are giving money up out of their pocket. They could be seeing patients. And they're there on the board because they feel that they have a real set of concerns. And again, I'm proud of the fact that the board of directors is made up of a fair number of them who have really been instrumental in what we do and how we do it. ALLEN LICHTER: Yeah. I have to be a little bit of a Homer and say, that certainly, Dan, you're at the University of Michigan. And I used to be at the University of Michigan, but we've had three presidents of ASCO in modern times, my presidency and your presidency, and now Lori Pierce. And of course, two of those people are-- 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 of those presidents were radiation oncologists from the department I used to lead. And we are very proud of the work that the Red Hawks from Michigan are doing inside ASCO. DANIEL F. HAYES: Go blue. I think that pretty much uses up our alotted time here. Is there anything else about the history of ASCO you think that our listeners ought to know about that they might not? ALLEN LICHTER: You know, we are regarded as really, a highly successful and highly effective society. Many organizations in medicine have come to look to ASCO for ideas, for policy positions, for ways of running the organization. We have a fabulous staff made up of both of about five physicians in our senior staff and a number of distinguished professionals who support our policy and membership in meetings, and so many other parts of our organization. We created the Journal of Clinical Oncology out of nothing and built it into the most important clinical journal in oncology today. It's an ever-changing critically important piece of the oncology 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 I said 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 done for me personally as well. And appreciate the time you spent with us today ALLEN LICHTER: Dan, it's been a pleasure. [MUSIC PLAYING]   DANIEL F. HAYES: Until next time, thank you for listening to this JCO's Cancer Stories-- The Art of Oncology podcast. If you enjoyed what you heard today, don't forget to give us a rating or review on Apple Podcasts or wherever you listen. While you're there, be sure to subscribe so you never miss an episode. JCO's Cancer Stories: The Art of Oncology podcast is just one of ASCO's many podcasts. You can find all the shows at podcast.asco.org. [MUSIC PLAYING]

Dr. Hayes served on the ASCO Board of. Directors, and served a 3 year term as President of ASCO from. 2016-2018.. But since you've had so much to do with ASCO, you've been a. president of ASCO, you've been a CEO of ASCO, you're pretty much. done it all, I thought we'd take an opportunity to pick your brain. about the history of ASCO.. That sentence, that this is not a society of. chemotherapeuticsts, as they wrote it-- because there were no. medical oncologists-- but was a society for cancer physicians of. all persuasions, was a fundamental organizing principle of ASCO, a. principle that holds true today.. And I like to say to people, you. know, what is really startling is that the field of medical. oncology, the medical oncologists forgot to establish the American. Society of Medical Oncology.. And so that dichotomy of, there is. the science, especially the bed science, and there's the clinical. science at the end of the week, existed for quite some time until. ASCO grew its meeting enough, worked out an arrangement with AACR,. and the two meetings divided, with AACR meeting in April and ASCO. meeting in June-- again, something that still exists to this. day.. ALLEN LICHTER: Over the years, not only did ASCO develop as a. national organization, but within each state, either a medical. oncology or an oncology writ large society was formed.. That grew in importance and we ended up creating the state. affiliate council and hearing from them at each board meeting and. then finally, to the point where we had the president of the state. affiliate council who was invited to attend every board meeting,. and to be part of the board deliberations.. DANIEL F. HAYES: Even to the extent that recently, we've set up. a separate business, I think it's called the Association of ASCO,. or ASCO assoc-- I can't remember what it's called.

Dr. Hayes interviews Dr. Allen Lichter for a second time on ASCO. Dr. Daniel F. Hayes is the Stuart B. Padnos Professor of Breast Cancer Research at the University of Michigan Rogel Cancer Center. Dr. Hayes’ research interests are in the field of experimental therapeutics and cancer biomarkers, especially in breast cancer. He has served as chair of the SWOG Breast Cancer Translational Medicine Committee, and he was an inaugural member and chaired the American Society of Clinical Oncology (ASCO) Tumor Marker Guidelines Committee. Dr. Hayes served on the ASCO Board of Directors, and served a 3 year term as President of ASCO from 2016-2018. TRANSCRIPT SPEAKER: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. 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 an ASCO endorsement. [MUSIC PLAYING]   DANIEL F. HAYES: Welcome to JCO's Cancer Stories-- The Art of Oncology, brought to you by the ASCO Podcast Network, a collection of nine programs covering a range of educational and scientific content and offering enriching insights into the world of cancer care. You can find all of the shows, including this one, at a podcast.asco.org. Today, our guest is Dr. Allen Lichter, the former CEO of the American Society of Clinical Oncology. Dr. Lichter has previously been a guest on this program in regards to his role as a radiation oncologist back in the early days and the research he did. But today, I'm going to ask him more about the history of ASCO. To begin with, Dr. Lichter has leadership roles with Cellworks and Lifelike. He has a consulting or advisory role with Integra, Ascentage Pharma, L-Nutra, and TRG Healthcare. He's also received travel 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 time we spoke, I really was focused on having you tell us about the evolution of radio psychology in this country, and was a terrific interview. 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 a president of ASCO, you've been a CEO of ASCO, you're pretty much done it all, I thought we'd take an opportunity to pick your brain about the history of ASCO. So to start with, I think a lot of our listeners probably don't know much about how ASCO got started in the first place. You want to 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 1940s and '50s, a few chemotherapy agents were invented and brought into practice. Toxicity was high. The benefits weren't that great. But there was some hope that through scientific discovery and research, things could get better. In 1954, the NCI created the first National Drug Discovery program, which began to catalyze the discovery of more chemotherapy agents. And it's into that environment that a group of, who were then internal medicine docs, started to use chemotherapy more and began creating some training programs in medical oncology. That led in the early '60s to an organizing meeting that took place 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 and formed an organization concerned with the management, the clinical management, of cancer. And you go back to that early meeting and read the following sentence, quote, "This society shall not be a society of chemotherapeuticsts only. The society should consider the total management of cancer." They established dues of $10 a year, and they agreed to meet again at the following spring. And on April 10, 1965, at the next AACR meeting-- or, actually, the original meeting was off cycle from AACR. And then, in '65, they met formally at AACR for the first time. That sentence, that this is not a society of chemotherapeuticsts, as they wrote it-- because there were no medical oncologists-- but was a society for cancer physicians of all persuasions, was a fundamental organizing principle of ASCO, a principle that holds true today. And it is one of the great strengths of ASCO, is that it welcomes and embraces and enjoys the membership of oncologists of all subspecialties. And then, as you move ahead in the development of medical oncology, you get to the American Board of Internal Medicine that had pressure from outside agitators, people like PJ Kennedy and Paul Calabrese and Paul Carbone, and Jim Holland and Tom Frei and Al Owens, to form and create a subspecialty board in this nascent specialty of medical oncology. And that came into fruition in the early 1970s. And if you go back into the '70s, ASCO had a revenue of $25,000. That was the annual revenue of the organization. It's now probably close to $150 million. And ASCO is number two in terms of the size of its revenue of all medical professional societies in the US behind only the American Medical Association. So that first idea of founding the society, creating it as a multidisciplinary society, and standing back and watching it grow as the specialties in oncology grew, has really borne fruit over many, many years. There were seven founders of the organization. Their names are in the ASCO office. People who come to the ASCO office can come into our big boardroom, which is called the Founder'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 only female in this group at the time, one of the few African-American medical oncologists in the nation. She had a distinguished career and has had many awards and tributes given to her both by ASCO and by AACR. So the society moved along. And I like to say to people, you know, what is really startling is that the field of medical oncology, the medical oncologists forgot to establish the American Society of Medical Oncology. They are, to this day, the only medical subspecialty in internal medicine that does not have its own dedicated professional society. ASCO has filled that role from its inception through the time that the specialty boards were created. And to this day, there is no ESMO, there is only ASCO. And so ASCO has this dual organizational responsibility, one to the entire field of oncology, and then a very special relationship with the field of medical oncology, as we represent that specialty almost exclusively. DANIEL F. HAYES: Let me jump in. There, for example, is a Society of Surgical Oncology and the American Society of Therapeutic Radiation Oncology, which I believe you were president of as well. So I agree with you that the internal medicine part of it is really unique in terms of ASCO serving as a society for everybody, even though there are these other societies that represent the individual modalities. ALLEN LICHTER: Yes. There is nothing quite like it. It has worked well. We have never, to my knowledge, had an uprising of the medical 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 attention to those special needs of community practice in oncology. But even then, virtually all the members of COA are members of ASCO as well. So as the society moved along and it grew beyond its $25,000 revenue, we hired a professional management firm to run the administration of the society, a firm called Bostrom. They were based out of Chicago. And for many years, a guy named Al Van Horn was 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 with ASCO until we got into the early 1990s. I was on the board at that time, but I'll digress for a moment to talk about how I got on the board. So at the annual meeting of ASCO, they always had a member's meeting. And it was like at 4 o'clock in the afternoon. And it was in one of the meeting rooms. And the dais was set with a long table. And the board of directors sat at the table. And the membership who, those that came, sat in the audience and heard from the leaders of the organization what was going on, et cetera, et cetera. And then, they had open mic that members could come forward and ask questions. So I arose from my seat and went to the microphone. And I said, gentlemen-- because they were all men-- you have extolled the multidisciplinary nature of this organization that existed from its founding up to the present day. But as I look at the assembled board in front of me, they are 100% medical oncologists. And you have radiation oncologists and surgical oncologists and pediatric oncologists and gynecologic oncologists and so forth in the organization. And we have no representation on the board. And they said, thank you, Dr. Lichter, for your question. And down I sat. But a little seed was planted, I guess. Because over the next couple years, the board decided to enlarge its membership and have dedicated seats for a radiation oncologist, a surgical oncologist, and a pediatric oncologist, seats that exist today. And I 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 got elected to the board as the first radiation-- sitting in the first radiation oncology seat. I watched as the society grew. And we recognized, we needed to take over our own management, to move away from the hired hands at Bostrom and to have our own organization. And it was under the steady hand of then President John Glick, who led us through this transition. We interviewed candidates to be the then called the executive vice president and hired John Durant, who was then at the University of Alabama. And John took us through that transition. We opened an office in Alexandria, Virginia, and began to hire staff. And John was an absolutely sensational leader for the organization during that important transition. And that was in kind of the mid '90s. John Glick was one of the truly terrific presidents of ASCO. And I contributed to that because I ran against John. And John wanted an election. And it was my doing that John became president of ASCO. I graciously lost to him. They decided, for some reason or another, that they would run me again for president. And I did win that election. I ran against Charles Balch, who was a surgeon. And Charles later succeeded John Durant as the CEO of ASCO as ASCO's second CEO. I was president '98-'99 was my year. And the organization continued to grow. I rotated off the board and was happily in my job at Ann Arbor. And then, Dr. Balch was stepping down and they were looking for a CEO. And I threw my hat in the ring and became the CEO of the organization in 2006. And that's a big, broad overview of the organization. It now has 45,000 members, as I say, a wonderful and steady revenue stream, although it's been a challenge over the last 18 months with COVID and losing the physical annual meeting. But those 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 the original meeting. And they were pretty interested in how do you dose 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, ASCO was principally a place to present your data and publish your papers in JCO. By that time, personally, I feel that it began to roll back into saying, look, 60% to 70% of our members are community oncologists. And I've seen a huge increase in ASCO's focus on the community oncologist. Is that perception all true, or am I making it up? ALLEN LICHTER: I think that that's true. If you look back at the first annual meeting in 1965, I think there were three or four papers presented. They were all clinical, and in some respects, as they should be. Because people wanted to begin to share their experience with using these new highly toxic agents. There was just no precedent. Everything was done through trial and error and clinical research and experimentation. And so the results were shared. And the society continued along in that vein not so much as a pure scientific society, and certainly, not so much as presenting basic science research, but presenting clinical research. I think at the time, it was felt that the more pure science was AACR. And ASCO was going to present the clinical stuff. And as you know, for the first many, many years of the society, the two societies met back-to-back. So a typical meeting in the 1980s was Monday and Tuesday was AACR. Wednesday was an overlap day, and then Thursday and Friday was ASCO. And so that dichotomy of, there is the science, especially the bed science, and there's the clinical science at the end of the week, existed for quite some time until ASCO grew its meeting enough, worked out an arrangement with AACR, and the two meetings divided, with AACR meeting in April and ASCO meeting in June-- again, something that still exists to this day. DANIEL F. HAYES: When you were CEO, though, for example, you initiated the Department of Clinical Affairs or something to that effect. 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 about that. ALLEN LICHTER: Over the years, not only did ASCO develop as a national organization, but within each state, either a medical oncology or an oncology writ large society was formed. And just about every state had them. It was not a revolutionary idea to begin to try to tie the affiliates into ASCO. Not that were floundering in any way, but they could use some support speakers to be arranged for their own annual gatherings. And we became much more interested in making sure there was a dialogue between ASCO central and what was going on in the trenches of physician practice in the community and around the states. And so we began to bring the state affiliates closer to the organization. A lot of this was done under the guidance of Joe Bailes, who was president of ASCO after me and had a prominent role in the government relations aspects of reimbursement aspects of the specialty. And Joe was very close to the state affiliates. That grew in importance and we ended up creating the state affiliate council and hearing from them at each board meeting and then finally, to the point where we had the president of the state affiliate 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. Medical oncology really, in essence, grew up as an academic discipline. It was started at major medical centers like Sloan Kettering and MD Anderson and so forth. You might be too young to remember, but patients used to be admitted to hospital to receive their chemotherapy. And they certainly were admitted, often admitted to hospital to receive their radiation to some extent, because insurance wouldn't pay for it if it was given-- and there was no such thing as outpatient cancer therapy. But as the specialty then began to move out of these large academic hospitals and into the community, that began this whole infrastructure of state affiliate societies and our relationship up and down. We are not just an organization of academics, although we've been led mostly by academic physicians throughout our history. The community oncologists have a very important role to play not only in ASCO, but in the delivery of cancer care in this country. DANIEL F. HAYES: Actually, I am old enough. I remember I told many fellows that when I was a fellow, we put people in the hospital. All we had was prochlorperazine, Compazine, which doesn't work at all. And we would give them barbiturates not because it kept them from throwing up, but it kept them from remembering how much they threw up so they would come back and get their next treatment. So it was pretty barbaric. Now, all outpatient, which is fantastic. Actually, you touched on this briefly, but how about the evolution of ASCO as an advocacy organization in politics, which has taken a major step lately? ALLEN LICHTER: Even while we were under the management of Bostrom, we did have a legislative government relations team in Washington. And the first couple of fulltime employees that ASCO had were hired in the government relations side. And a lot of this was really, again, we had to represent medical oncology in important areas of billing and reimbursements and Medicare coverage and 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 represent medical 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 the complexity of Medicare and Medicaid and private insurance, and the cost of care and inpatients and outpatients, and who's going to pay for what, where, and so on, and so forth, we have become deeply enmeshed in that. Because, again, it's our responsibility to do so. And I think the society over the years has done an excellent job of representing this field. DANIEL F. HAYES: Even to the extent that recently, we've set up a 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 Clinical Oncology. Anyway, it's named so that it can also be called ASCO. But when ASCO was founded-- and this makes us different from a lot of our sister societies-- we were founded as a 501(c)(3). That's the tax code, educational organization. And as a 501(c)(3) educational organization, we could not engage very much in what is known as lobbying. We could advocate for legislation. We could do some gentle advocation for legislation. We could interface with regulatory agencies. So we were unlimited in our ability to talk to the FDA or the CDC or the Centers for Medicare and Medicaid and that. But we couldn't do very much on the legislative side. And we thought for a long time about whether that needed to be remedied or not. In the end, it was decided it did need to be remedied. That is, we needed to have the ability to have a bigger footprint inside Capitol Hill in the legislative process. Virtually, all our sister societies had that. And many of them were founded 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 for Clinical Oncology, that allows us to have a more visible presence on the legislative side of the house and the ability to influence legislation on behalf of cancer patients and cancer physicians. DANIEL F. HAYES: Yeah, I think most of our membership, probably especially the academics, have always just thought, well, I don't have to worry about this. ASCO has my back. And what I have seen in the last 10 years is, first of all, an increasing presence of ASCO on 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 even when I got elected, I think there were 40 of us that did this. I had never done it before. It was a lot of fun, where we go out and meet with the senators and representatives and their staff, and with specific issues that we think are important for our patients. We just did this virtually last week. And I think there were 130 of us or something. That's increased quite a bit. And those discussions are now being led by what is essentially a PAC, a political action committee, this association but with a lot more influence that has had in the past. And I know I sound like I'm on a soapbox, but I've become a true believer, maintaining what you and your predecessors continued to emphasize, which is that we are not a trade union. We are there to improve patient care. And that's what we do. The topics we choose to discuss are related to things we feel need 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 ASCO who's done this. ALLEN LICHTER: Yes. And with the political action committee, it does give us the chance to have a presence at certain events that before, we couldn't, we could not have a presence then. It allows us to have influence as we can support those legislators that are sympathetic to the work that we're trying to get accomplished, and so on, and so forth. We resisted it for so long, it was time and the appropriate thing to do. And I join you in being proud of the organization to have just done it. DANIEL F. HAYES: So that's an advertisement. If any of our listeners would like to become part of the day's on the Hill, if you go into the volunteer corps, you can sign up and ASCP staff will 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's actually a lot of fun to do. And this association has very real guardrails set up so that we continue to advocate and lobby, again, for what we think is best for our patients. And that's another reason I was very supportive of it when it came around. ALLEN LICHTER: Your mentioning of volunteers makes me want to comment. Many of our sister societies, when I was CEO, the organizations that got together a couple of times a year were saying how difficult it was to get members to participate in the work of the society. Everybody was so busy in their practice environment, or their academic environment, or whatever. ASCO has always had exactly the opposite problem. We have way more of our dedicated members who want to participate in the society than we have places for them to participate. So it's a wonderful problem to have. It has been that way for as long as I can remember, and continues that way today. It's a real tribute, I think, to the specialty as to how dedicated our members are in being willing to volunteer and serve, and really devoting a huge amount of time. You've been president. You've been on the board. That service is all volunteer and takes, over a career, hundreds and hundreds and hundreds of hours. But people do it actively and willingly. And our only problem is I wish we had more spots for people to have positions inside the organization. DANIEL F. HAYES: When I became president, I think I had 220 slots, or something like that, to fill. And I had something like 2,000 people volunteer. And I agree with you. Actually, was it under your watch that the designated seats for community oncologists for the board became a reality? Or was that before you? ALLEN LICHTER: That existed before. That was added. And I can't remember if it was added at the time the subspecialists were added or whether it came a separate thing. But yes, and it goes to what we were talking about before, which is with community oncologists, we felt very important even as today, that they needed a seat at the table for ASCO. So we have this dedicated seat for a community oncologist, and even have brought community people into the undesignated seats. We learn a lot from our community colleagues and need them and have them close at hand. DANIEL F. HAYES: I have said many, many times before I was on the board and when I was president that the academics, including myself, will speak up to show you how smart they are. But the community oncologists on the board were there for a very real reason. And I learned very quickly my first year on the board, keep my mouth shut and listen to these folks because they had a lot to tell us. They're there because they want to make things well. I think the academics are too. They want to make things better. But the community oncologists are giving money up out of their pocket. They could be seeing patients. And they're there on the board because they feel that they have a real set of concerns. And again, I'm proud of the fact that the board of directors is made up of a fair number of them who have really been instrumental in what we do and how we do it. ALLEN LICHTER: Yeah. I have to be a little bit of a Homer and say, that certainly, Dan, you're at the University of Michigan. And I used to be at the University of Michigan, but we've had three presidents of ASCO in modern times, my presidency and your presidency, and now Lori Pierce. And of course, two of those people are-- 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 of those presidents were radiation oncologists from the department I used to lead. And we are very proud of the work that the Red Hawks from Michigan are doing inside ASCO. DANIEL F. HAYES: Go blue. I think that pretty much uses up our alotted time here. Is there anything else about the history of ASCO you think that our listeners ought to know about that they might not? ALLEN LICHTER: You know, we are regarded as really, a highly successful and highly effective society. Many organizations in medicine have come to look to ASCO for ideas, for policy positions, for ways of running the organization. We have a fabulous staff made up of both of about five physicians in our senior staff and a number of distinguished professionals who support our policy and membership in meetings, and so many other parts of our organization. We created the Journal of Clinical Oncology out of nothing and built it into the most important clinical journal in oncology today. It's an ever-changing critically important piece of the oncology 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 I said 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 done for me personally as well. And appreciate the time you spent with us today ALLEN LICHTER: Dan, it's been a pleasure. [MUSIC PLAYING]   DANIEL F. HAYES: Until next time, thank you for listening to this JCO's Cancer Stories-- The Art of Oncology podcast. If you enjoyed what you heard today, don't forget to give us a rating or review on Apple Podcasts or wherever you listen. While you're there, be sure to subscribe so you never miss an episode. JCO's Cancer Stories: The Art of Oncology podcast is just one of ASCO's many podcasts. You can find all the shows at podcast.asco.org. [MUSIC PLAYING]

Dr. Hayes interviews Dr. Allen Lichter for a second time on. ASCO.. Today, our guest is Dr. Allen Lichter, the former CEO of the. American Society of Clinical Oncology.. But since you've had so much to do with ASCO, you've been a. president of ASCO, you've been a CEO of ASCO, you're pretty much. done it all, I thought we'd take an opportunity to pick your brain. about the history of ASCO.. ALLEN LICHTER: I think to understand ASCO, you have to go back,. really, to the very beginnings of medical oncology.. And I like to say to people, you. know, what is really startling is that the field of medical. oncology, the medical oncologists forgot to establish the American. Society of Medical Oncology.. There, for example, is a. Society of Surgical Oncology and the American Society of. Therapeutic Radiation Oncology, which I believe you were president. of as well.. Because people wanted to begin to share their. experience with using these new highly toxic agents.. And ASCO was a (c)(3).. in the end, we formed a new (c)(6), which is this Association for. Clinical Oncology, that allows us to have a more visible presence. on the legislative side of the house and the ability to influence. legislation on behalf of cancer patients and cancer physicians.. Many of our sister societies, when I was CEO, the. organizations that got together a couple of times a year were. saying how difficult it was to get members to participate in the. work of the society.. DANIEL F. HAYES: I have said many, many times before I was on. the board and when I was president that the academics, including. myself, will speak up to show you how smart they are.

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