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Elaine Jaffe - Transcript Summary

Elaine JaffeChief, Hematopathology Section, Laboratory of Pathology, CCR, National Cancer Institute

Interview location: National Institutes of Health, Bethesda, Maryland
Interview date: 28th November, 2007

Key Themes: Attributes of a PathologistNew Technologies, Research versus Clinical Work

 


 

Profile   |   Transcript Summary   |   Full Transcript

 

Section 1

  • Parents were immigrants from the Ukraine
  • Fascinated by astronomy, geology and fossils as a child, but at school her interest turned to biology:  “The science of living beings seemed more interesting than rocks and stones.”
  • It was a family with strong commitment to education, and she and her sister went to Cornell university. “In those days most of the Ivy League institutions did not allow women -- you couldn't go to Harvard or Yale or Princeton, they were 'all male' until probably the late '70s, early '80s".
  • In training as a medic she was swimming against the tide: she was one of only five women in her class of 100 students.  “In the '50s a woman stayed home and raised children.”
  • It was in her second year that pathology began to interest her:  “Looking through the microscope I kind of saw medicine come alive...I wanted to understand disease and what caused it.”
  • As her training progressed she realised there were aspects of clinical work to which she was not suited. “I was just very squeamish: I didn't like hurting people, so when I had to go draw blood I was terrible at it!”
  • This was one of the reasons she chose to specialise in pathology.  “I never had this Florence Nightingale fantasy of healing the sick... I didn't go into medicine because I could help humanity; I went into it because I thought it was interesting to study.”
  • Marriage during the Vietnam War and background to decision to have a child
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Section 2

  • Goes to National Cancer Institute as only the second woman to do a residency there.  
  • Followed this with a fellowship in haematopathology.
  • Muses on the existence of a ‘glass ceiling’.  “I think if there are glass ceilings they're subtle.” 
  • Mentions that there are very few women branch chiefs or principal investigators at the NIH – “and it's changed very,very little over the past 25 years”.
  • Her early training in pathology was at Georgetown, where she had no problems with autopsy work.  “I wasn't squeamish about autopsies, no. It's the idea of the patients feeling pain, rather than blood or gooey stuff...”
  • Relates an anecdote about how as a student she failed to find the key organ, the pancreas, for diagnosis during an autopsy.
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Section 3

  • Picks up the story of her time at the National Cancer Institute. “I started my rotations at a time when... the first successful cancer therapies were being introduced.” 
  • Some of the most exciting developments were in the field of immunology, where she chose to focus her research.
  • She talks in detail about how T cells and B cells were being recognised for the first time. 
  • She was involved in seminal work to find ways of identifying these immune system cells in tissue, using sheep red blood cells.  “We thought: this is really exciting.  Maybe we can use this to understand lymphomas... At the time nobody knew what the cells of origin were of lymphomas... The classification of these cancers was very primitive.”
  • Her team published a key article on follicular lymphoma in 1974 in the New England Journal of Medicine, which became a 'citation classic '.
  • Lymphoma has been the focus of her research ever since.
  • Describes in detail the new technologies, such as monoclonal antibodies, that were making this pioneering work possible in the early 70s.
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Section 4

  • Describes new insights into cancers of the immune system.  “The focus of our work continued to be to try to understand how all the lymphomas related to the normal immune system, and what phenotypic and functional properties were retained.”
  • They began to refine the classification of lymphomas, with the result that “what started out originally as lymphosarcoma, reticulum cell sarcoma, Hodgkin's Disease, now is probably more than 60 subtypes of lymphoma.”
  • Talks about “lymphoma politics”: “It was very confusing for clinicians, because everybody was using a different classification scheme... How could you compare your patients treated with your chemotherapy regimen at your hospital with a study being done in France or Germany, where the classification was totally different? You were comparing apples and oranges.  So it was a very politicised time, and there was a lot of fragmentation in the pathology community.”
  • Eventually some consensus was achieved, and “in 1994 we published something called the Real Classification, which was the revised European and American lymphoma classification.  That was published in Blood, and actually became the most highly-cited article in all of clinical medicine over the next 10 years”.
  • This was soon adopted by the World Health Organization and has had a significant influence on treatment of lymphoma: “I'd say there is much more of an attempt for disease-specific therapy today, and targeted therapy.”
  • Gives some examples.
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Section 5

  • Discusses what has been discovered about how lymphomas arise, and the central role played by translocation of genes.  “The clue to understanding cancer is understanding its molecular basis.”
  • Explains the role of the pathologist in improved disease definition: “It starts off with the pathologist seeing something distinctive [under the microscope], and then it evolves and ultimately comes full circle to where you redefine the entity” using some of the new tools.
  • Talks about the advantages of being a working pathologist in the research team: “As pathologists we see the disease more in its entirety -- in terms not only of its morphologic features or its molecular pathogenesis, but its clinical features also, and this is very important.”
  • Describes her work with patients at the NIH: “I also receive a lot of cases for consultation – about 2,000 a year from all over the US and the rest of the world.” 
  • Mentions some geographic differences in epidemiology.
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Section 6

  • Discusses some of the “eureka moments” of her career.  For example, “after the introduction of monoclonal antibodies... there were no limits to what you could dissect out and the various sub-populations that you could discover.”
  • Talks about what it takes to be a good pathologist: “I think that you have to be born with a certain visual aptitude. I can tell the first month when I sit down with a resident whether they have got it or not... Some people who will look down the microscope day after day after day and never get it.  They just can't capture those images.”
  • She believes that this aptitude is often manifest as a love of art.  “My husband and I...buy a lot of art.  The only problem we have right now is we've run out of walls!”
  • Expresses her concern about the stranglehold of bureaucracy: “The rules now are so  restrictive that if you followed them to the letter it would really harm medical research.”
  • She feels that patient advocacy groups have “missed the mark”, although she recognises some of their concerns, especially in relation to genetic studies. “I think certain protections are necessary.  But I think it's gone too far.”
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Section 7

  • Returns briefly to talking about her family, and how she juggled motherhood and career.
  • Mentions some of the influential people in her life including her mother.
  • Talks about her work with clinicians at the NIH Clinical Center, which is unique in being exclusively a research hospital.  Refers to some specific cases, in particular the children’s disease auto-immune lymphoproliferative syndrome.
  • Mentions recent advances in understanding Hodgkin’s lymphomas.
  • Talks about motivation and some of the rewards of her work.  Relates a case where her diagnosis saved a patient from radical and unnecessary treatment.
  • Emphasises the importance of visual memory as well as visual aptitude.  “People joke with me here because... I'll look at a slide and say, ‘Oh that looks just like Mrs. Jones from 1978,’ and I'll run into my office and grab a slide and come in with it.”
  • Returns to the topic of follicular lymphoma and her particular interest in the interplay between malignant cells and immune system.
  • Touches upon how her own family has been affected by cancer.

 

 

 
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