nicholas l. petrakis md - Anthropology, History and Social Medicine ...

Interviews with
NICHOLAS L. PETRAKIS M.D.
postwar cancer research
at ucsf
Pro fessor and Chairma n Emeritus o f
Preventive Medicine a nd Epidemiology
Sch ool of Medicine, U niversity of California, San Francisco
THE UCSF ORAL HISTORY PROGRAM
DEPARTMENT OF THE HISTORY OF HEAL TH SCIENCES
UNIVERSITY OF CALI FORNIA, SAN FRANCISCO
INTERVIEWER: NANCY M. ROCKAFELLAR, Ph. D.

INTRODUCTION AND INTERVIEW HISTORY
[Mike Shimkin] had a quote he stole from the NCI, 'An epidemiologist is what
an epidemiologist does,'...it’s true people come into it from various directions
and various backgrounds. I came into medicine wanting to do research and I
found hematology and then subsequently oncology as a fascinating area...At
that time I hardly knew what epidemiology was because in medical school it
wasn't being taught, other than what you picked up in microbiology as
infectious disease epidemiology....but at that time the whole projection of the
future would be that there would be minimal infectious disease and we would
be dealing with these chronic conditions, heart disease and cancer....And
social ideas, social forces, sociology in medicine was becoming a factor, and
anthropology....I always felt that epidemiological research can go in several
directions.
Nicholas L. Petrakis, M.D.
Born on February 6, 1922, in Bancroft, Iowa, Nicholas Petrakis spent his
entire childhood in the Midwest and recalls the bleak Depression and dust storms of
South Dakota in the 1930s. He began a path toward medicine early, attending
Augustana College in Sioux Falls, receiving a B.A. in Zoology and Chemistry. He
went on to the two-year program in medicine at the University of South Dakota and
then transferred to Washington University in St. Louis, studying hematology under
Carl Moore, and received the M.D. in 1946. The immediate postwar years brought
him to Minneapolis General Hospital for an internship and residency. Like most of
his generation of medical students, World War II and the mid-century doctor draft
significantly affected his career, placing him in the Navy and an accelerated medical
school program at South Dakota and Washington University. In 1949, draft
obligations led him to the West Coast, first to Seattle and later to the Radiation
Damage Control School on Treasure Island in San Francisco Bay. There he recalls his
first contact with personnel from the UC School of Medicine. In 1950 he accepted a
US Public Health Service Position as senior assistant surgeon working at the NCIfunded
Laboratory of Experimental Oncology (LEO) associated with the UC School
of Medicine. There he found a 15-bed experimental ward devoted to the study of the
physiology of cancer and the investigation of new therapies. He recalls, "It was all
new....In the LEO almost everybody had leukemias and lymphomas or a few solid
tumor patients...we were really involved with those patients and it was very, very
exciting."
In this interview, Dr. Petrakis graciously spent a significant amount of time
discussing his experience as a young clinical investigator at the LEO and his
impressions of Dr. Michael Shimkin, director of the lab, and a national figure in early
postwar cancer research. In 1947, well before the NIH's 500-bed Clinical Center was
complete, this small prototypic Laboratory of Experimental Oncology was created at
the University of California with ample federal funding and the hesitant, often
ambivalent cooperation of the medical school faculty. From 1947 to 1953, Dr.

Michael Shimkin and a group of young physicians, including Dr. Petrakis, treated
cancer patients with experimental therapies and treatments in one of the earliest
postwar settings for human experimentation. Working from the details of Shimkin's
own written accounts, this interview explores the LEO story in depth, looking at such
issues as the use of permission and release forms, the ethics of human
experimentation, early clinical trials, and the sometimes troubled relationships
between UC faculty members and the physicians working at the LEO. At the
midpoint of this interview, Dr. Petrakis presented many detailed records of the LEO's
everyday protocols and alerted us to the presence of scrapbooks, photographs and
other documentary materials placed in the UCSF Library's Archives and Special
Collections. His interview provides a valuable, nuanced, personal account of
everyday practice within the wards and laboratories of the LEO. Pertinent materials
are reproduced in appendixes B, C, D, and F.
After the LEO was closed by NIH officials and clinical research was
centralized in the new Clinical Center in Bethesda, Dr. Petrakis remained at UCSF,
conducting research within the Cancer Research Institute (CRI). In the mid-1950s
clinical trials of chemotherapy were centralized and standardized by the Cancer
Chemotherapy National Committee at Bethesda and Dr. Petrakis continued his
previous oncological work, conducting cooperative chemotherapy trials at San
Francisco for this national program. Here he provides insight into CRI director David
Wood's laissez-faire administrative style and the state of instruction and research on
the San Francisco campus as the basic sciences returned after a 52-year hiatus. In the
mid-1960s Dr. Petrakis served as acting chair of the troubled Department of
Preventive Medicine and he carefully traces the shift from an unfocused curriculum,
to the creation of a Department of Epidemiology and International Health and, most
recently, the Department of Epidemiology and Biostatistics.
In the late 1960s a series of summer sabbaticals drew Dr. Petrakis into the
expanding field of epidemiology and, from this time on, his concern for genetic
markers for cancer became the dominant theme of his research, supported by an NIH
Program Project Grant titled "The Natural History of Benign Breast Disease and
Breast Cancer." His reflections on the minority presence of sociology, anthropology
and health services concerns on campus provide an important perspective on the
development of social medicine at UCSF, a process overshadowed by dramatic
discoveries in molecular biology. Dr. Petrakis traces the earliest roots of concerns for
the social and behavioral sides of medical care, from Ralph Audy's and John
Saunders' formulations of "human ecology," through innovations within the Division
of Ambulatory and Community Medicine, and the development of varieties of
sophisticated epidemiological studies on campus. His account elucidates the early
development of health services research on campus, first formally institutionalized by
Dr. Philip Lee in 1976 with the formation of the Institute for Health Policy Studies. In
this interview Dr. Petrakis traces the campus fate of medical anthropology and the
social and behavioral sciences, providing an important perspective on the current
consolidation of these elements in the new Center for Social, Behavioral and Policy
Sciences, now supported at the highest administrative levels at UCSF.

This interview was conducted on the fourth floor of the old UC Hospital with
Dr. Petrakis, a most versatile and informed senior statesmen of the UC School of
Medicine. Since his intimate involvement with early postwar cancer research was a
special area of departmental historical research interest, Dr. Petrakis consented to be
interviewed in more depth on the subject of his associations with Dr. Michael
Shimkin and the Laboratory of Experimental Oncology in the early 1950s. The
second half of the interview assumes the usual program format with a detailed
consideration of Dr. Petrakis' career at UCSF considering key shifts in administration
and the continuous development of the field of epidemiology in this institutional
context. Dr. Michael Thaler, a master’s student in the Department of the History of
Health Sciences at the time of the interview, participated in the sessions with
permission of Dr. Petrakis. The reader is directed to the UCSF Health Sciences
Library for the documentary records of the LEO, the School of Medicine's Cancer
Board minutes and other rich collections of papers relating to the development of
epidemiology, social sciences and health services research on this campus. Dr.
Petrakis' broad vision and close observations do much to enliven and tie together
these disparate elements of intellectual and disciplinary development at UCSF.
Nancy Rockafellar, Ph.D., July 1998

INTERVIEWS WITH NICHOLAS L. PETRAKIS
MARCH 21 & 22, 1996
CONTENTS
Acknowledgments v
Foreword xi
Introduction and Interview History xii
EARLY LIFE AND EDUCATION
Early Life .......................................................................................................................1
Medical School in Wartime: the Navy at University of South Dakota .........................3
Washington University at St. Louis...............................................................................4
Internship in Minneapolis ..............................................................................................5
Navy Service in Seattle..................................................................................................5
POSTWAR RESEARCH IN SAN FRANCISCO
Radiation Damage Control School in San Francisc.......................................................6
First Contact with UC School of Medicine ...................................................................6
Connections between Oncology and Hematology, ca. 1950 .........................................8
LEO Relationships with Radiology ..............................................................................11
Comparison of UC with Stanford .................................................................................15
The Rarity of Research Positions in the mid-1950s .....................................................17
David Wood Comes to Direct the Cancer Research Institute, 1951.............................18
LABORATORY OF EXPERIMENTAL ONCOLOGY
The Laboratory of Experimental Oncology Dispersed: Impact on the CRI .................19
Characterizing the Laboratory of Experimental Oncology...........................................19
A Last Resort for Cancer Patients.................................................................................20
Designing Experiments.................................................................................................20
Microspectrophotometric Measurement of DNA .........................................................20
Study of the Physiology of Cancer ...............................................................................21
Priority Disputes over the Portal Puncture Technique .................................................25
Review of LEO Rounds by UC Internists.....................................................................26
Role of the Consultative Tumor Board.........................................................................26
Laurens P. White Arrives at the LEO ...........................................................................28
Howard Bierman's Arrival, 1947 ..................................................................................29
Visiting Professors........................................................................................................29
CANCER RESEARCH
The Languishing of Clinical Research in Cancer: Post LEO .......................................30
From the CRI to the Department of Preventive Medicine............................................31
The CRI as a Referral Center........................................................................................33
Significance of Nonpaying "Teaching Cases" in the CRI ............................................33

CONTROVERSIAL EXPERIMENTS
Symposium on Human Experimentation ......................................................................35
Policy Revisions: Cancer Board Review......................................................................38
Geographical Full-time .................................................................................................40
Howard Bierman Leaves the LEO................................................................................43
Controversial Experiments ...........................................................................................44
M . B. SHIMKIN BIOGRAPHY
Background on Dr. Michael Shimkin ...........................................................................46
Michael Shimkin's Return to UC to Direct the LEO, 1947 ..........................................47
Turf Wars between Michael Shimkin and Robert Stone ..............................................49
Failure to Integrate Laboratory and Bedside Studies at LEO.......................................50
Medical Schools as Hierarchies....................................................................................52
Beginning Work in Epidemiology................................................................................53
Michael Shimkin's Later Career ...................................................................................55
Shimkin's Involvement in Breast Cancer Studies.........................................................55
Professor of Human Cancer Biology at Temple University .........................................56
FROM LEO TO CRI
David Wood's Administrative Style at the CRI ............................................................57
Comments on the Transcutaneous Approach to the Portal Vein ..................................58
Interpersonal Rivalries..................................................................................................59
New Scrutiny Prompted by the President's Committee on
Human Radiation Experiments.....................................................................................61
Authorship Patterns on LEO Scientific Papers.............................................................61
Early Chemotherapy Trials at the LEO ........................................................................63
Supplementing Medline with the World Wide Web.....................................................65
Early Clinical Trials: Protocols and Deficiencies.........................................................66
CAREER TRANSITIONS
Career Transitions.........................................................................................................67
Meeting Rudi Schmid at Minnesota .............................................................................68
CRITICISM OF LEO PROTOCOL
The Laboratory of Experimental Oncology and the Legal Release Form....................70
The Predominance of Legal Concerns..........................................................................71
Responsibility to the Department of Medicine.............................................................72
Criticism Leads to Review of Procedures and Practices ..............................................73
PREVENTIVE MEDICINE
Transition to Epidemiology ..........................................................................................73
Department of Preventive Medicine, 1956 ...................................................................75
Context of the Times.....................................................................................................76
Sample Lectures in Preventive Medicine .....................................................................77

TRANSFORMATION OF THE SCHOOL OF MEDICINE
Characterizing Research at UC in the mid-1950s.........................................................79
Impact of the Return of the Basic Sciences, 1958 ........................................................79
The Cancer Research Institute and the CVRI...............................................................81
An Independent Campus in San Francisco ...................................................................82
Reform of the Department of Preventive Medicine......................................................82
Accelerating Changes Within the Medical School.......................................................84
Committee to Construct a New Department.................................................................89
A New Department of Epidemiology and International Health ...................................90
Research in Epidemiology and Sickle Cell Disease .....................................................92
Bringing Medical Anthropology to UCSF....................................................................94
AMBULATORY CARE
Memories of Robert Credé............................................................................................95
Bringing Allied Health Professions Together in Ambulatory Care..............................96
Introducing Health Risk Appraisal ...............................................................................99
CANCER EPIDEMIOLOGY
Conversion to Epidemiology: Ear Wax Studies in American Indians..........................99
The Study of Breast Cancer and Nipple Aspirates .....................................................101
Interest in Etiology......................................................................................................103
The Search for Genetic Markers in Cancer Epidemiology.........................................104
CAMPUS TRANSITIONS
Creating a San Francisco Program in Medical Anthropology....................................107
Transitions in the Hooper ...........................................................................................110
On Choosing a Successor ...........................................................................................113
Attempt to Create a Liver Center at the Hooper.........................................................114
J. Michael Bishop Directs the Hooper Foundation.....................................................115
DEPARTMENT OF EPIDEMIOLOGY
Biostatistics on Campus..............................................................................................116
The Split Department of Epidemiology......................................................................117
Virginia Ernster as Chair of Epidemiology and Biostatistics.....................................118
Formalizing Biostatistics [1989].................................................................................120
Need for Molecular Epidemiology: Preserving Laboratory Space.............................121
Newer Developments in Epidemiology and Biostatistics...........................................124
Index ...........................................................................................................................126

APPENDICES
Appendix A: Nicholas L. Petrakis: CV and Bibliography
Appendix B: Public Health Officers in the Laboratory of Experimental Oncology,
San Francisco, 1952
Appendix C: LEO Consent Form and 1951 Revisions
Appendix D: Complete Bibliography of LEO Research Papers
Appendix E: Essays on Human Ecology
Appendix F: Symposium Papers on “The Problem of Experimentation on Human
Beings”
Appendix G: Reconfiguring Preventive Medicine and Epidemiology on Campus
Appendix H: Caricature of Herbert Johnstone, Associate Professor of Medical
Parasitology
Appendix I: Biography of Ralph J. Audy
Appendix J: Summary of Work in Breast Cancer Epidemiology