Pulling Back the Curtain
Robert P. Gale, MD, PhD
In this edition, Robert P. Gale, MD, PhD, offers an honest appraisal of how medicine and research have changed in recent years and talks about his varied career
and atomic hematology. Dr. Gale is visiting professor of hematology at the Imperial College London, is executive director of Clinical Research in Hematology and
Oncology at Celgene Corporation, and serves on the editorial boards of several
scientific journals.
write; he said hematology. (I won’t
repeat his opinion of oncologists.)
Who were the mentors who
helped shape your career,
particularly at its start?
There were many, of course, but
most important were Martin Cline,
MD, the chief of hematology and
oncology at UCLA; David Golde,
MD, a professor of medicine at
UCLA where I was pursuing my
PhD; Dr. Valentine; and John Fahey,
MD, my PhD advisor.
And, of course, the great philosophers Montaigne and Woody
Allen.
was an expert at buying dresses.
Eventually, I realized that most
people in the haute couture industry
die of a massive heart attack at an
early age. Not for the faint-hearted,
as they say – especially if you have
to deal with Parisians in August to
meet deadlines. Medicine seemed
a more rewarding, and less nerveracking, direction.
Robert P. Gale, MD, PhD, from top
left, taking a sand bath, disguised as
a Canada goose, and ice climbing in
Montana’s Hyalite Canyon.
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ASH Clinical News
What was your first job?
My first job was working in my family’s haute couture business in New
York. I started delivering fabrics
and, after several years, advanced to
working with famous designers like
Norman Norell and Donald Brooks.
I liked draping the models! Many
stars came in to purchase costumes
when I was there. I was especially
impressed whenever Cary Grant visited; all the models swooned. Grant
had five wives and a partner, so he
How did you decide you
wanted to specialize in
hematology?
From the beginning of my medical
training, I wanted to focus on trying to improve leukemia therapy
because it seemed like a dreadful
disease, robbing children and young
adults of their lives. Before I even
went to college, I had picked out hematology, and leukemia specifically.
At the end of my training in
internal medicine, I sought counsel
from my chief of medicine at the
University of California, Los Angeles
(UCLA), William Valentine, MD.
I was deciding between hematology
and cardiology. Two things he said
influenced my decision: First, he
noted the heart is merely a pump
whose role it is to distribute blood to
the body – the blood’s the thing! He
also asked me if I wanted to write
the music or play the music. I said
What advice would you pass
on to beginning-career hematologists and oncologists?
Identify your talents early on – figure out what makes you happy and
challenges you both professionally
and personally. Is it the rigor of science, the art of medicine, a combination of both? Where do you want
to be in 10 years?
Sometimes there’s a perverse
disconnect: Many people want to
do things they are least-suited for
and avoid areas where their talents
shine. If introspection and mindfulness fail to answer this question,
ask your spouse. He or she will set
you straight.
What have been the biggest
changes you’ve seen in medicine throughout your career?
Several come to mind. First, when
I started my career, it was possible
to be a superb clinician and also
to make a substantial basic science
contribution in the laboratory.
The recent buzzword “translational medicine” was not in vogue
then, but that’s what it was: the
physician−scientist. I think those
days are quite over.
Achieving this balance is increasingly difficult for a few reasons.
Clinical medicine and basic science
have become far more complex. One
cannot simply pop into the lab after
a day making rounds or in the clinic
and hope to make a meaningful scientific contribution. Second, therapy
options and treatment algorithms
have become increasingly complex
and sophisticated. For example,
when I began treating patients with
chronic myeloid leukemia, all we
had was busulfan and hydroxyurea.
Now, we have several tyrosine kinase
inhibitors, interferon, transplantation, and more. This is marvelous
for our patients, but determining the
best use of these interventions for
each of them is challenging. This is
especially true because clinical trials
are designed to determine the best
therapy or therapeutic strategy for a
cohort, not for an individual. However, as physicians we make decisions on the person level, not the
cohort level. Many people forget this
important distinction. Third, there
are now massive amounts of data
one needs to process to be a competent physician–scientist. Finally,
the electronic medical record – a
usef ul but diabolical invention – has
entered our lives.
What types of questions do
you ask in an interview?
My goal is to identify smart people.
There’s a difference between a
person who seems smart because
he or she has mastered a specific
technology and someone who can
think through problems. My goal is
to train physicians to make complex
decisions that will result in the best
outcomes for people diagnosed
with complex diseases. This requires
many skills. Mastering considerable
data is one of these skills. However,
the skills needed to be a good physician are far more complex – for example, the ability to deal with uncertainty or to formulate a probabilistic
approach to diagnosis. These are the
traits I look for.
As we learned from an informal
study my UCLA colleagues and I
conducted several years ago, the
interview questions may not be as
important as who the interviewee is.
June 2016