Christopher Fletcher - Transcript Summary

Christopher FletcherProfessor of Pathology at Harvard Medical School, Director of Surgical Pathology, Brigham and Women's Hospital, and Chief of Onco-Pathology, Dana-Farber Cancer Institute, Boston

Interview location: His office at Brigham & Women's Hospital, Boston.
Interview date: 20th November 2007

Key Themes: Relationship with clinicans, Life, death and the hereafter, Mentors and Influences, MotivationAttributes of a pathologist

 

Profile | Transcript Summary | Full Transcript

 

Section 1

  • His upbringing in a medical family.  Never thought of doing anything else but medicine. 
  • How he discovered pathology and was beguiled by it. Found himself working in a very strong department at St Thomas’, under the ‘inspiring’ Michael Hutt. “We used to do all the stuff from Malawi and Tanzania and other places, so we saw astounding pathology that you would never ever have seen in central London.”  
  • For him the decision to specialise in pathology was clinched by the realisation that “it's the underpinning of so much medical care”.  
  • Talks about the current demoralised state of pathology in UK--  “One thing that has screwed pathology, or academic medicine, in England is this dramatic division between research and clinical service”-- and by contrast, the high morale he has found among pathologists at Harvard.
  • Talks about starting out as a young pathologist, and what thrilled him most: “making a diagnosis, influencing the decision-making, educating clinicians – and being a patient advocate.”
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Section 2

  • How he developed an interest in soft tissue tumours – almost by 'accident': asked to write a paper on these tumours, and got hooked. 
  • Talks about how he developed a specialist practice in London for the NHS. 
  • How the field of soft tissue tumours has developed over the years – increased understanding has allowed for greater refinement of categories.  
  • Referrals grew fast,  as did the unit’s expertise – “you can get 100 of something that other people only see six of in a lifetime, and it helps you work out how they behave and so on.”
  • Defines ‘soft tissue’ tumours and explains the importance of increased understanding:
  • “Soft tissue things are notorious for the difficulty of separating the benign from the malignant.”   But as he points out, “for every malignant one there are about 100 benign ones.” 
  • Describes his “terribly stressful” experience of Thatcher’s ‘internal market’: “When [Harvard] tried to recruit me, it wasn't very difficult to decide where I'd be better off.”
  • The categorisation of tumours proceeds apace: over the last 20 years “we've defined or described for the first time lots of tumour types that were not formerly recognised.”
  • Makes the case that much of this work was “done by looking down a microscope... Not using modern molecular biology.”
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Section 3

  • Discusses the conflict between basic science research and clinical services.
  • Tackles another controversial issue – radiation treatment for cancer as a cause of cancer in later years. “It’s a swings and roundabouts thing.  It’s something nobody ever talks about in medicine.”
  • The difficulties of challenging dogma, and the impact of new technologies such as immunohistochemistry:“Now [the science of pathology is] much, much more objective, and there is less dogma around than there was.” 
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Section 4

  • But new technology doesn’t have all the answers: “The more genetic information that’s discovered, the more you find that completely different tumours have identical genetic signatures.”
  • Some very interesting descriptions of actual tumour types and how they were discovered, with some patient anecdotes.
  • Makes the point that skill grows with experience.  “We probably see more of these soft tissue things than anybody in the world now, and it does give you a unique perspective.”  But at the same time,“more and more we realise that there are a lot of tumours we can’t predict”. 
  • Stresses the importance of being able to admit when you are flummoxed, and not to see this “as a sign of weakness”. 
  • Muses about different personality types in medical profession.
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Section 5

  • Talks about contact with patients.  “Some people do go into pathology to avoid patient care, but I loved it.”
  • How, as one rises in the profession, the administrative burden increases.  He runs a huge department: “We have 75,000 surgical specimens a year.  I have 60 odd faculty...  and 40 odd trainees.  There are more than 100 doctors who are all in some way... related to surgical pathology.”
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Section 6

  • Current research projects – focussed particularly on teasing out the mystery of how tumours arise.  Stresses the importance of open mindedness in research and readiness to recognise new things: “...all of a sudden you have 100 [cases] of something that half the world says is impossible.”
  • Emphasises the thrill of research that proves clinically useful.  Illustrates this with reference to specific cases.
  • Discusses the mysterious phenomenon of tumour cells changing their tissue type: “There’s some cell in there that in some way has flipped -- it’s turned into another cell type during the course of going bad.”
  • The evidence seems to suggest that there are new cancer types developing all the time, and others becoming rarer.
  • Accummulating large amounts of data is the key to such observations.  But the human factor is also important: “If I took any credit, it’s more for being open minded than anything else – not trying to force things into existing categories.”
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Section 7

  • Talks about what motivates him: “The fun bit is seeing lumps and working out what they are.  And feeling as though you’re helping patients.”
  • What being a pathologist has taught him about living and dying, and also how he realises that we are all 'dispensible'.  
  • His charitable work, including the violin school for disadvantaged children in Boston.
  • A bit about his own family life – his role as a father when his three daughters were growing up.  
  • Returns to the issue of decline in autopsy rates, and the various contributory factors.

 

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