Clark and professionalism

By Bryant Boutwell and Charles M. Balch

What is professionalism in medicine? It’s a compass within one’s being to be practiced daily without a second thought. It means adhering to high ethical and moral core standards, subordinating self-interest to that of others, reflecting on one’s actions and decisions, responding to societal needs, active participation in professional organizations, continued learning, commitment to scholarship and accountability. 

Going down that list, Lee Clark hits the mark on all. He knew them and he lived them. Clark was a sterling role model for professionalism for all who trained and worked in his sphere. He not only modeled these attributes but also recruited for them, and he institutionalized them into the heart and soul of MD Anderson. 

Continuous learning, accountability and reflecting on your work with constant improvement in mind — all link to professional organizations.  On Clark’s curriculum vitae, the number of professional organizations and his service to them fill pages. He reached outside the hospital, providing leadership of numerous professional groups at the national and international level. One book on Clark attempted, unsuccessfully, to list them all, single spaced, small font, on one page. 

Consider just a few: president of the American Cancer Society (1976-77) with decades of committee and board service; chair of the American College of Surgeons’ (ACS) Commission on Cancer (1959-1964), with more than three decades of service earning him the ACS Distinguished Service Award; senior member of the Society of Surgical Oncology, for which he received the coveted Lucy Wortham James Award and the James Ewing Lecturer Award; founding president of the Association of American Cancer Institutes; election to the prestigious American Surgical Association; founding member of the Southwestern Surgical Congress; founding member of the Society of Head and Neck Surgery (today the American Head and Neck Society); senior member of the American Thyroid Association (one of his surgical specialties); honorary life member of the board of directors of the Texas division of the American Cancer Society and more.

You get the idea. With more than 300 peer-reviewed publications, he was all about scholarship and committed to facilitating continuing medical education on an international scale. He had trained with the best, including the Mayo brothers at their famed institution in Minnesota, where accountability was central to every activity. The Mayo name was built on the science of documenting outcomes and always striving to better those outcomes in the interest of each patient. In 1948, Clark established one of the nation’s first departments of epidemiology for a cancer hospital under the leadership of Eleanor Macdonald. He built his institution’s reputation on accountability. He looked for the best benchmarks of progress in cancer care and always tried to better them.   

As a member of Lyndon Johnson’s 1965 Commission on Heart Disease, Cancer and Stroke, he was a national voice for important national initiatives. In 1970, chairing the National Organizing Committee for the 10th International Cancer Congress in Houston, he helped organize a meeting that attracted 6,000 physicians and scientists. Yes, 6,000. It was an amazing accomplishment not completed until he oversaw the writing and publication of the proceedings. He was a doer, and he recruited those who shared his drive to make a difference and be the best. Many of his recruits (too many to name here) went on to lead national and international professional organizations for their specialties and subspecialties.

The word “trendsetter” comes to mind. Today MD Anderson is annually ranked among the best of the best in the nation for cancer care. That hard-earned accolade, for which every MD Anderson employee can be proud, traces back to Clark.

No wonder Pres. Richard Nixon named him in the early 1970s as one of three members and the senior scientist for the President’s Cancer Panel. Clark helped craft Nixon’s National Cancer Act signed in 1971 and served on the panel for five years. MD Anderson was designated one of the country’s first three comprehensive cancer centers along with Memorial Sloan Kettering and Roswell Park in Buffalo, New York. In this way, MD Anderson became the prototype for other cancer centers in the U.S. and throughout the world. He was no longer looking for benchmarks to better — his cancer hospital was now the benchmark for others to strive to become.

In 1976, during his tenure as American Cancer Society president, Clark traveled widely promoting cancer control activities at the local, state, national and international levels. More than a few of those trips were to Washington, D.C., to educate Congress on key medical issues and funding needs. He understood that the social contract of medicine was to go beyond individual patient care and address the bigger picture of societal needs for cancer-related education and preventive strategies. Thanks to his tireless networking and recruitment of faculty who followed his example, what could have been a small, local cancer hospital in Houston became an international force. 

From the day Clark took the job in 1946, he was networking across the nation to study best hospital designs, best organizational structures and best strategies to help cancer patients. He measured his institution against the best, always striving to improve while carefully documenting progress made. Accountability was always a driving force, and this approach assured that the fledgling cancer hospital built of repurposed military barracks at the Oaks would rise to prominence. 

“We can build a place of quality,” were his self-assured words to the UT System Board of Regents on the day he was hired. To him that meant a place that was better than good, a gold standard to which others would aspire.

Clark developed a scientific publications office that became a model for faculty at other institutions. In 1948, with his childhood friend Russell Cumley, he launched the Cancer Bulletin to share the work of a small cancer hospital with a big mission. The journal was remarkably successful, with over 100,000 subscribers at its peak. It was the beginning of a series of journals and books written with professional and lay education in mind. For many years, Clark published the Yearbook of Cancer, which summarized the entire cancer literature. With Cumley he published “The Book of Health: A Medical Encyclopedia for Everyone,” which went to three editions. While Drs. Denton Cooley and Michael DeBakey brought international renown to the Texas Medical Center in the 1960s for heart care, Clark and his team brought international renown for cancer care.

Starting at the Oaks, he built a small roomful of books into one of the world’s leading libraries for cancer-related topics, including rare holdings such as a complete set of Virchow’s 1847 Archiv für pathologische Anatomie und Physiologie und für klinische Medicin. By 1961, MD Anderson’s library had nearly 22,000 books and volumes of periodicals, with 700 journal subscriptions.  

Those color cameras in the new hospital’s operating suites in 1954 (the first in the nation) speak directly to Clark’s focus on training with new technology. MD Anderson was ahead of its time producing training films. When we talk about innovations, there are early adopters, middle adopters and laggards. Clark was an early adopter among early adopters who left the laggards to catch up.  

Clark welcomed reporters, as he had a message about cancer that he wanted people to know. His ability to sort through data and interpret for the media made him a go-to source. The many conferences MD Anderson coordinated over the years also were magnets for global science writers and medical reporters, who were accommodated and appreciated for their role in disseminating new cancer information with practical public value. Efforts invested in educational programs, Clark said, would multiply many times over through the value of patient care and research.

At the Oaks he already was organizing professional meetings, starting with a few chairs in a small room and moving to a larger auditorium in the medical center. Even when the new hospital was dedicated in 1954, the central focus beyond a formal ceremony and tour was a two-day gathering of scientific minds to compare notes and learn the latest in cancer research and treatment. The proceedings were then published and disseminated widely. If it was worth doing, said Clark, it was worth publishing and sharing.

Over his 32 years as president, through conferences, symposia, discussions, lectures, publications, motion pictures, television and exhibits, Clark put an international spotlight on MD Anderson and the caliber of his faculty and staff. After retiring in 1978, he remained active until his death, in 1994. He appraised new technology in the late 1970s and arranged an international satellite broadcast as part of a continuing education colloquium to celebrate MD Anderson’s 40th anniversary. Today, in a COVID-19 world of routine virtual meetings, teleconferencing seems old hat. In those days, it was the stuff of early adopters, and Clark was there. Words like “status quo” never made it into his dictionary. 

Clark found inspiration in Sir William Osler (1849-1919), a great humanistic physician and a timeless role model whom many consider the father of modern medical education. Osler helped build Johns Hopkins’ medical school, the gold standard to which Abe Flexner compared all medical schools in his 1910 Flexner Report, a report card that transformed medical schools across the country. Like Clark, Osler taught through example what professionalism in medicine was all about. Like Clark, Osler’s active participation in professional organizations was impressive. Like Clark, Osler held himself accountable through publications and presentations before peers at professional meetings. Osler taught his students at the bedside, where real learning takes place. Clark took Osler’s methodology and added training films and grand rounds while bringing clinicians and basic researchers together to accelerate discovery from laboratory to bedside.

Time after time, Osler and Clark took on the challenges before them. Each reminded their faculty and students that they were treating a person, not a disease. Osler added that the practice of medicine would exercise their hearts and minds. Clark insisted that cancer treatment included the patient and the family. He recruited departmental leaders who agreed and in turn recruited their own faculty and staff who carried the torch forward. 

Science may change, but the attributes of professionalism remain timeless. The words of Clark’s successor, Dr. Charles LeMaistre, in his 1994 memorial tribute are worth repeating. 

“For those of us privileged to have known and worked with him, to have been inspired by his vision and tenacity, we are grateful for his remarkable legacy of healing and hope,” LeMaistre said. “People in every corner of the world — most who will never know his name — are in Dr. Clark’s debt.” 

Next article: Grant Taylor, pediatrician and educator