Leaders in Medical Education: Dr. J. Leonard Lichtenfeld, Deputy Chief Medical Officer for the American Cancer Society

len picLeonard Lichtenfeld, M.D., M.A.C.P., deputy chief medical officer for the American Cancer Society, is responsible for directing the Society’s Cancer Control Science department. This group of internationally recognized experts focuses on the prevention and early detection of cancer, as well as emerging science and trends in cancer. The department is responsible for producing the Society’s widely recognized guidelines for the prevention and early detection of cancer, including the role of nutrition and physical activity.

Dr. Lichtenfeld is also recognized as a resource both within and outside the Society for his expertise in oncology and medical affairs. He serves as a liaison for the Society with many professional and public organizations, and is a frequent spokesperson on behalf of the Society on a variety of cancer-related subjects.

A board-certified medical oncologist and internist who was a practicing physician for more than 19 years, Dr. Lichtenfeld has long been active in medical affairs on a local, state, and national level. He is active in several state and national medical organizations.

Dr. Lichtenfeld is a graduate of the University of Pennsylvania and Hahnemann Medical College (now Drexel University College of Medicine) in Philadelphia. His postgraduate training was at Temple University Hospital in Philadelphia, Johns Hopkins University School of Medicine and the National Cancer Institute in Baltimore.

You can follow him on Twitter @DrLen and on his American Cancer Society Blog. 

 

How did you get interested in medicine?
I had a broad range of interests as an undergraduate at University of Pennsylvania. When I was there, I majored in sociology. I wasn’t a particularly good science student, but I was still very interested in medicine. I was offered an Economics position at Wharton and had also been considering law school. I had a professor in economics during that time ask me “Don’t you want to think for a living?” and I think that phrase really shaped how things unfolded for me.

I turned down the offer from Wharton and accepted a spot in medical school, even though it was supposed to be a reach for me. Even though I wasn’t science oriented, I believe my social science background offered a challenge for me to think about problems and their solutions in a different way. I think one of the issues when I completing my medical school applications, which did help me out in the end, was that other students who were applying were very interested in and focused on the sciences. The idea that I didn’t have a science major was a bit unique. Fortunately, I did well academically. I’m grateful that I was accepted and was able to pursue this career.

 

What made you pursue internal medicine and oncology?
This was another situation where I was fortunate to have options. I was interested in surgery. My mentor at the time was Dr. Koop, the former surgeon general, who I had spent time with during surgery rotations as a student. My goal was to become a cardiac surgeon. But, it became clear for personal reasons that I wasn’t going to be able to pursue that path. It was then a choice between cardiology and medical oncology. Then I was accepted to the National Cancer Institute for a fellowship program, which ended up dictating my future career. It just became a matter of making the choice.

I have realized that medicine as a career provides many options as you make your career choices. Some people are focused when they come in and know what they want to do while others like me have to deal with some choices that put them along specific paths. My choice of going into cancer medicine was serendipitous but I definitely made the right decision.

 

What was your journey to take you where you are now?
Not only have I been a physician, I have also had a number of “mini” careers along the way as well. Back then I did things a bit backwards. I actually did my fellowship at the National Cancer Institute before I did my residency in internal medicine at Johns Hopkins. I ended up being a part of the first wave of trained oncologists who went into the communities. There were no cancer centers or many resources to support cancer care and cancer patients at the time, but I knew that I wanted to be able to give back.

I knew that I had a broad range of interests, tools and skillsets and took advantage of opportunities that came my way. I became involved in the local, state, and national level with healthcare policy and professional organizations. Along the way I developed expertise in media, public speaking, and public/professional education in the Baltimore area. I also developed an interest in litigation and continued my engagement with public policy.

I think this brings to light one of the most underappreciated things about medicine: The field opens the door to a wide range of opportunities and experiences.

I participated on national health policy committees and for several years hosted my own radio show. I worked with litigation on behalf of physicians. I eventually left practice for a period of time and became involved in business. The type of career I had was so varied, that I couldn’t encompass it in any typical position.

After a few years in business ventures I came to the American Cancer Society as a medical editor. When I arrived at the Society, there were other opportunities. If someone needed a comment for the press about a particular journal article, I made myself available. I also had knowledge about public policy and was able to engage in health policy discussions within the Society which helped me get more involved with the organization. Eventually, about a year and half after I arrived, the Chief Medical Officer asked me if I wanted to run the Cancer Control Science department, which was responsible for society’s guidelines for prevention and early detection of cancer. I focus now more on media, public policy and internal and external organizational relationships.

I was fortunate and blessed that I had those opportunities throughout my life and was able to take advantage of them. The Cancer Society has supported me in various engagements and allowed me to participate in public policy issues through discussions with FDA and other legislative and regulatory groups.

Medicine gave me a venue to have these stimulating, engaging, and challenging opportunities that sustained my interest well beyond the more typical limits of my chosen profession.

In the early portion of my career, being a successful physician was frequently about rote memorization, reflexed responses, and the ability to think on your feet at 2am. Most of us were not chosen because we were team players or because we had a larger world view. Instead it was because we were focused and committed and willing to commit to the regimentation it took to be a successful physician. When I say my mold was different, it was realizing that although taking care of patients is important as a physician, there are other ways to engage in a medical career outside of patient care.

Now there is more awareness and sensitivity about having a broader view as a physician. There is more to being a doctor than being an outstanding student of organic chemistry. The social and psychological elements—among others–are also important. Our profession is becoming more holistic in its thought processes and expectations.

The skill-sets and knowledge you need to have today and how one is chosen to be a physician are different than they were in the past. Some may find that uncomfortable, but others think it’s a good thing. Regardless medicine remains a challenging career and one of the greatest careers an individual can pursue. It’s still an honored profession and brings incredible value to patients and communities as well as a large amount of personal satisfaction.

 

What are some of the biggest advancements that we should keep our eyes on with regards to treating cancer?
There are two major things to consider in cancer treatment as we go forward: Genomics and Immunotherapy

Genomics involves understanding the genetics of cancer and what makes a cancer cell a cancer cell. The thing with genomics is that you might get an answer to your question but it might lead to more questions. I have an admiration for those who understand this. The research has produced some incredible insights into how cells function and how we can address cancer more effectively. We are struggling a bit to keep the research funding in place, but we must if our knowledge is to continue advancing. There’s an issue of translating genomics from the lab to the bed side and developing drugs that will make cancer a chronic disease and cure it. To get where we need to go with genomics, we need research commitment and expansion of genomics within the practice of oncology. We must do clinical trials more efficiently and effectively and find patients to participate in clinical trials which in turn make new treatments available.

With regards to immunology, I’d like to point out that the comments made today describing how immunotherapy will rid body of cancer are the same optimistic comments we made in the 70s (to harness the body’s immune defenses to treat cancer). It was a dream up until now. Now immunology is having a huge impact. With continued research we will better understand how to leverage our innate immune system to treat and prevent cancer..

We will also have to look more carefully at cancer care from a population perspective. Cancer is a disease of the aging, and with more people becoming older and living longer, we will see more individuals with cancer. Will we have the right professions to handle this? Will we have high quality and effective healthcare IT available? Will the people get access to the right care? It’s a logistical and political issue that we will face going forward.

 

I see that you have worked a lot with healthcare policy. I was wondering what are two or three changes you would like to see in how healthcare is run in the United States?
I want to see every patient get the right care that they need as well as get the assurance that the care they receive is of the highest quality. We, as patients—and I have been a patient on several occasions–take a lot of things on faith. The good news is that many physicians are committed to caring for their patients and assuring the quality of that care. I would like to have more certainty of that assurance however. There are a lot of forces at play that may not be in patient’s best interest.

As we move forward in policy, we are entering a new era with payments called ‘value based.” Unfortunately, history has taught me that we have great ideas that don’t tend to meet expectations when looking back. I would hope the payment system will succeed in putting patients front and center and be certain patients receive necessary and appropriate care. I see too many situations where someone recommends a test or procedure, even though it wasn’t necessary or appropriate in certain circumstances

 

Along those lines, the United States receives a lot of negative attention with all of the screening we do despite poorer health outcomes. What are your thoughts on this issue?
When looking at the data the biggest performance indicator is longevity. After that, it is how much we spend to get there. We don’t have the longevity of other countries and we are spending a lot more as well. We need to ask ourselves what we are doing right and wrong and have to be willing to scrutinize our offerings to patients. Our care system is so disjointed and the patient-doctor relationship piece is under siege.

In a conversation with a patient, a doctor has to be able and willing to say that he/she can do “x” or “y” for the patient and it won’t affect your health outcome very much if you were to do it. Right now physicians are going through everything to rule out any possibility that is out there.

A relative of mine in his late 80s went to a highly regarded primary care organization and had a routine exam. He said he had a headache that morning and soon thereafter he was getting a CT scan. The record did not document a history or a physical after the comment. It was straight to the scanner.

I have also had experiences in my own and my family’s care where tests were recommended just to be sure and to have an abundance of caution. We need to recognize that we are doing things for patients that might not be necessary for them.

Doctors also need to be attuned to the patient’s preferences and what they want to make sure they are comfortable with the level of care they are receiving. We need to take patients considerations to heart– especially in cancer care–to understand quality of life.

We also need to pay attention to the evidence to understand the benefits to certain screenings. I remember when I was an oncologist in the 70s, one of the things we prayed for were tests to spot cancer early thinking we could save lives if only we could find every cancer at the earliest moment. With prostate cancer, when we finally developed a screening blood test , there was no trial available that showed the screenings made a difference with overall health outcomes from the disease. However, we all wanted to believe that it did. Furthermore, with breast cancer we have studies that say that annual screenings at the age of 40 might not be suited for everyone. We do know that cervical cancer screening has reduced deaths and so has colon cancer screening.

The lesson about screening is just because we want to believe it works isn’t the reason enough to assume that it works. When the evidence doesn’t meet our expectations, it doesn’t mean the evidence is wrong. There was a generation of physicians and people in the community who grew up knowing nothing other than screening. When faced with the fact of uncertain evidence, people tended to trash the evidence. Medicine is moving towards an evidence basis. Unfortunately, there are still plenty of opportunities for people to sway our thoughts.

 

Do you have any additional final thoughts?
I keep coming back to this new generation of medical school students. My wife (who is a practicing ob/gyn) and I are so impressed with what this generation brings to the table. With their commitment and experiences, my greatest hope is that they succeed and not lose their optimism and sense of inquiry as they incorporate life experiences into the profession they are embracing.

You frequently don’t’ know what your day will be like in medicine. It’s the opportunity to embrace new challenges. Medical school is difficult and being a physician is a commitment and hard work, but don’t lose sight of who you are, what you want to be, and the world around you and the experiences it offers. This generation is bringing so much to medicine and you are incredibly well prepared. We wouldn’t make it in medical school today because we wouldn’t be as prepared as you all appear to be. Medical students today have more varied life experiences, and are more well-rounded even before your first day as a medical student. So keep the faith, keep the commitment, and keep the promise that being a doctor and helping our patients is still one of the world’s most noble professions.

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