Clement Richard Boland, Jr., MD: a conversation with the editor

Rick Boland (Figure 1) was born on October 19, 1947, in Johnson City, New York, and grew up in nearby Endwell. He graduated from the University of Notre Dame in 1969 and from the Yale University School of Medicine in 1973. His internship in internal medicine was at St. Francis Hospital in Hartford, Connecticut. After his internship, he served for 2 years as a general medical officer at the Gallup Indian Medical Center in Gallup, New Mexico. He completed his residency in internal medicine at the Public Health Service hospital in San Francisco and did a 3-year fellowship in gastroenterology at the University of California at San Francisco (UCSF) School of Medicine. He was an assistant professor of medicine at UCSF from 1981 until 1984, when he went to Ann Arbor, Michigan, as chief of the gastroenterology section of the Veterans Administration (VA) Medical Center; he soon became a full professor of internal medicine at the University of Michigan School of Medicine. After 11 years in Ann Arbor, he moved to San Diego, California, where he was chief of the division of gastroenterology at the University of California at San Diego (UCSD). He remained in that position until 2003 when Baylor University Medical Center (BUMC) attracted him as its chief of the Division of Gastroenterology in the Department of Internal Medicine.

Figure 1.

Dr. C. Richard Boland during the interview.

Dr. Boland has had an outstanding academic career. Because many of his family members have had cancer of the colon, he was determined to learn more about this entity. He has contributed more to our understanding of the familial variety of cancers of the colon and rectum than anyone else and, indeed, he has identified the unique mutation in the gene that allows this cancer to occur in multiple family members. His research has led to the publication of nearly 200 articles, most of which are in peer-reviewed medical journals. He has also been a visiting professor at numerous academic centers in the USA and abroad. He is married to the former Patricia Sweeney, and they have three very talented daughters. Rick Boland is a great guy and a tremendous addition to BUMC.

William Clifford Roberts, MD (hereafter, WCR): Dr. Boland, I appreciate your willingness to talk to me and therefore to the readers of BUMC Proceedings. Could we start by talking a bit about your early upbringing, some early memories, your parents, and your siblings?

Clement Richard Boland, Jr., MD (hereafter, CRB): I grew up in a small town in upstate New York. I was born in 1947 in the same hospital where my mother had been born; I was in the first wave of the Baby Boomer generation. My parents met in Washington, DC, and married when my father was a fourth-year medical student at Georgetown University (Figure 2). They came back to Johnson City, New York, for his internship. During his internship, my older sister, Sue, was born, and then he was sent off to Italy in the service. He became ill in Italy and returned home.

Figure 2.

Clement R. Boland, Sr., and Catherine J. Armstrong at the time of their wedding in Stamford, New York, 1944.

My parents settled in the town where my mother grew up. My father was from Reading, Pennsylvania. I was one of four kids, two girls and two boys, each 2 years apart. We had a very close and happy family. I was the second child. It was a time when many families had lots of children. There was a lot of activity in the streets after school—playing football, basketball, or baseball. It was a happy time, with an old-fashioned innocence, because there was essentially very little crime. People didn't lock the doors to their homes or their cars. Some would even leave their keys in the car when they parked downtown.

My father was a pediatrician. There were only two pediatricians in the western end of Broome County. He was a real fixture, if not a pillar, in the community. He gave all the children at school the polio vaccine when it was brand new.

We moved locally two times. When I was 4, my parents bought a colonial house on River Road in Endwell, New York, on the banks of the Susquehanna River. The town I grew up in had a population of 5000 to 10,000 people. Endwell was sandwiched among Binghamton, Johnson City, and Endicott, each of which had between 30,000 and 60,000 people. They were locally called the “Triple Cities.” The whole county probably had about 250,000 people in it. There was an interesting mix of new immigrants. The western end of the county had many Italian immigrants, and the eastern end had immigrants from Eastern Europe. They mostly came toward the end of the 19th century and the beginning of the 20th century as each of the local industries evolved. In the early 20th century, the Endicott-Johnson Shoe Factory was the biggest industry in town. At one time it was the largest shoe factory in the world. As that industry faded about the time I was born, a new industry, initially called Endicott Time Clock, which morphed into IBM, arose. Endwell thus became an IBM town, and IBM was the biggest employer in the western end of the county. There weren't many minorities in Endwell, and it was evenly divided between Protestants and Catholics.

WCR: Was dinnertime a big deal in your home?

CRB: Yes, it really was. My mother was a homemaker. My father worked long hours as a pediatrician. He worked late and often was not home for the family dinner, but he was always home on Tuesday nights. He came home for dinner, ate, and went back for evening office hours. He was always home on Sundays, and the family was together on Sunday for an afternoon dinner. For the last 10 years of his life, he took Thursday afternoons off, which meant he was home by 5:00 PM, so we had one more family dinner together. My father was, in every way, the spiritual leader of the house. However, the day-in, day-out work ethic was completely dominated by my mother. She set the rules for behavior, home chores, and homework. My father came from a large Irish Catholic family, and my mother came from an Anglo-Saxon Protestant family of English, Dutch, and Scottish descent. Her family had been in New York State for a long time.

WCR: When you sat down at the dinner table on Tuesday evening or Sunday, would your father dominate the conversation?

CRB: Yes. He was the center of attention but did not hinder full discussion by the family.

WCR: What did you discuss as a rule?

CRB: There was a lot of discussion about the family members and how things went at school. There was emphasis on achievement and on doing the right thing. Achievement meant accomplishing something that would be beneficial to the rest of society. In my father's eyes, being a doctor was at the top of the chain of public service. He also regaled us with many, many family stories, both real and exaggerated, and he made up a series of imaginary creatures who were woven into these tales.

WCR: What was your father like at home? What was your relationship with him? Was he warm and easy to deal with?

CRB: Yes, he was. He was a very loving person. As a pediatrician, he had an affinity for children. I was named after him. He was Clem and I was Rick. When I was very young he was my hero, the one I looked up to and aspired to be like. That was a daunting challenge. He had a keen intellect and had been a tremendous athlete as well. He had been a state champion quarter-miler in high school and a star basketball player. He came from a large family, the 12th of 13 kids (Figure 3). His father died when he was 5. He was raised by his mom, towards whom he had an almost religious devotion, and his older brothers and sisters. There was no money for him to go to college, but when he won the state track meet in the quarter mile, he got an athletic scholarship to Albright College in his hometown. I saw him as the guy who did everything well and who had achieved in all aspects of life. As an adolescent, it was a little terrifying to aspire to live up to that. He wouldn't say I had to be like him, but it was an expectation I had for myself.

Figure 3.

Family of Dr. Boland's father, taken in the 1930s in Reading, Pennsylvania. His grandmother is in the front row, second from the left. His grandfather was not alive at the time. His father, Clement R. Boland, Sr. (front row, third from left, next to mother) was the 12th of 13 children.

WCR: Was he a big man?

CRB: He was 6 feet tall, probably 180 pounds. If there was a neighborhood baseball or basketball game, he was always the best. He was very humble about these things, but he was a terrific athlete.

WCR: Few major athletes, it seems to me, become pediatricians. He must really have been a nice guy. I don't think I've ever met a pediatrician I didn't like.

CRB: He also was a very good-looking man. He was not arrogant, and of course, he was grateful to be alive. He also had a kind and warm way with people.

WCR: When he got in very late at night did he complain the next day?

CRB: He almost never complained. His patients were in three different hospitals, which he visited each day. He did house calls too. He might get home at 8:00 or 9:00 PM. As we got older, we were often up when he came in. He also had office hours all day on Saturday. We all went to church with him on Sunday and then he'd visit a couple of hospitals and do house calls; the four children would go with him and wait in the car.

WCR: Did any of your siblings become physicians?

CRB: No. My oldest sister is a guidance counselor in an elementary school in the Triple Cities. My younger sister is a special education teacher and recently became a vice principal in Rochester, New York. They each have two master's degrees in their fields. My younger brother is an executive in the pharmaceutical industry, has been quite successful, and lives near Philadelphia (Figure 4).

Figure 4.

Jim, Rick, Alice, and Sue (siblings), 2003.

WCR: What was your mother like?

CRB: She was really something. She had a lively personality and was the life of every party she went to. She was an attractive blonde and diminutive (5′1″ in height) and had a considerable spirit. She also cleverly figured out how to get my father to do whatever she wanted him to do. Although few people knew this, in high school she became deaf from otosclerosis. She could read lips—as well as minds. She had been a good student earlier, but as she went deaf, she did less well in school. Her mother had owned the Maple Farm Inn in the Catskills, and before her marriage my mother wanted to move back there and run the inn. I believe she was accepted into the Cornell School of Hotel Management, but her father wouldn't let her go. (I think he must have been a bit like Archie Bunker and didn't think that girls should be educated.) At that point she decided the best way to get out of Johnson City and see the world was to join the Waves (the women's naval corps during the war). She was sent to Washington, DC, where she met my father. My sister was born 11 months after they married. The inn-keeping was put on hold until after my father died.

WCR: You mentioned that your father became ill in Italy. What was that all about?

CRB: In Italy he began having abdominal pains and lost quite a bit of weight. They thought he had an ulcer. It turned out that he had colon cancer at age 26. He went from his “fighting weight” of 180 pounds down to about 140 pounds. They finally sent him home. My mother went to New York City to pick him up and didn't recognize him because he was so gaunt. He was too weak to get up off the stretcher. She took him back to Johnson City, where he had a colon cancer operation. The cancer was a large cecal tumor with multiple metastases to regional lymph nodes.

WCR: That was in 1946? There was no chemotherapy then.

CRB: Correct, no chemotherapy. They told him to take radiation therapy, but he refused. In fact, he told my mother that he was getting radiation so there was no need for birth control. That's why I was born; he never took the radiation therapy. Many years later I realized that he had familial colon cancer: his father had had colon cancer, and his grandfather, as well as several of his siblings, had had colon cancer or one of the other cancers associated with this disease. My father was a very religious man, and he felt that he survived because he prayed. He believed that he was allowed to go back to work so he could dedicate himself to taking care of children and raising his family. He did little else in terms of getting any kind of screening, not that there was any screening of value during the 1950s or 1960s. He then developed another colon cancer when he was 49, during my first year of medical school, and that one was fatal. That was 1969, 23 years after the first cancer.

I went to my various professors and told them that I thought that there was familial colon cancer in my family. They asked me if there was familial polyposis, and I told them I knew that there was not. They told me that there was really no such disease as familial colon cancer without multiple polyposis. I did my medical degree thesis on familial cancer. I located and interviewed all the relatives I could find. I got pathology records, did a literature search, and then did some bench research to determine if there was a linkage between the HLA type and the tendency to develop cancer. I did carcinoembryonic antigen measurements on the blood of asymptomatic family members. All those failed; we had no tools to chase down a genetic disease at that point in time. I was convinced that the cancer in my family was genetically determined. During my thesis writing in 1972,1 came in contact with Dr. Henry Lynch. He had published an article in August 1971 in Cancer and described a large family similar to my own. I also found another family like mine in New Haven when I was a subintern. I took care of a 36-year-old man who came in with a pulmonary embolus, and we found he had a rectal cancer. Five of his 12 siblings and his mother had colon cancer.

WCR: These were all adenocarcinomas?

CRB: Yes.

WCR: Is that where your father's neoplasm was?

CRB: Both of his were in the proximal colon. Actually, when my father had his final cancer at age 49, he had two more colorectal cancers at the same time. My grandfather had had a colon cancer at age 27 and later died of rectal cancer at age 46. My dad had a sister who died of colon cancer at age 27.1 knew that there was something more than bad luck going on, but most professors I spoke to attributed the cancers in my family to bad luck. The cancers, however, were clustering in families, occurring early, and occurring in the proximal colon. I later figured out that the cancers also tended to be mucinous and poorly differentiated. All of these characteristics have stood the test of time as more families have been reported. For a number of years I assumed that I would have colon cancer and probably the same outcome. I had several negative barium enemas, but that procedure is pretty insensitive for detecting colonic cancer. When colonoscopy finally became routine, I had it done regularly and encouraged other family members to do the same.

WCR: Have any more cancers been found in family members?

CRB: Unfortunately, yes. Of course, the family is large; I have 25 first cousins on my father's side alone. I had a cousin who died of endometrial cancer and gastric cancer, both of which are part of this syndrome. An uncle with whom I was close after my father's death died of gastric cancer. Of the 13 siblings in my father's family, 10 have had cancers. I was motivated, to say the least, to try to figure out what was going on. I had a sense of urgency to do something of value early because I thought I might not live past 30 years or so.

After my internship, I went into the Public Health Service with the Indian Health Service in Gallup, New Mexico, for 2 years doing general practice. After those 2 years I finished my medicine residency in San Francisco. About that time I gradually realized that I was leading my life with an excessive concern of being stalked by cancer or death. In fact, I used to say offhandedly to friends that I probably wouldn't live to be 30, so long-term planning was not important. When I reached age 30, I realized that I was likely to live longer. I finally got the insight that I wasn't leading my life properly. I also realized that I felt angry—at no one in particular—because my father had died of this disease, no one had the answers to why this was going on, and, worse, I might get it too. Then I realized that the best way to deal with this would be to study the disease myself. Instead of being stalked by cancer, I should stalk it instead. It gave me a much better perspective on life and a reason to pursue the work that I did.

WCR: That's a fantastic story. Did you publish your family genetic tree in your thesis in medical school?

CRB: I did. I later published it as a free-standing publication because there was very little understanding of the genetic basis of colon cancer,and very few families like this had been reported (Figure 5).

Figure 5.

Family tree drawn from Dr. Boland's medical degree thesis on familial colon cancer, 1973, as published in a review in 1983. When the figure was published, no member of generation IV had developed cancer. Dr. Boland is IV-19.

WCR: Did your father have a long illness?

CRB: He was sick for about 8 months. When I came home for Thanksgiving in my first year of medical school, I hugged my dad before going back to school, and he winced with some pain. It was the tumor. He died the next July.

WCR: You had a firm grasp on colonic cancer long before you made a research career out of it.

CRB: Yes.

WCR: What was your home like growing up? Were there a lot of books around? You say that your mother encouraged all of you to do well in school. Did you read a lot growing up?

CRB: I did not. There were not a lot of books around the house. Neither of my parents read a lot. My father worked all the time, and I don't think my mother was an avid reader. When I hit seventh grade (Figure 6), something happened and I had a hard time reading. I might have been slightly dyslexic at the time. I'm left-handed, which is sometimes linked with reading problems. I didn't read well for a while, and then I worked and overcame it. I transferred from the school of science into the school of liberal arts when I was in college because I knew that science came very easy for me and I got only As in those courses, but I struggled with literature, writing, and reading. I had a 150-point gap between my math and verbal aptitudes on my college boards. I made myself get better. Now I write grants and manuscripts all the time and read voraciously.

Figure 6.

At age 12 in Endwell, New York, 1959.

WCR: Were you an athlete growing up?

CRB: I always participated, but I wasn't in the class of either my father or my brother, who also was an elite athlete. I was on the track, cross-country, and swimming teams. In my senior year of high school, I swam the 100- and 200-yard freestyle events. I won a couple of races, but I wasn't any kind of star. My little brother, in contrast, was probably the best in the state in the backstroke and held the pool record in the backstroke at Maine-Endwell High School for 25 years. I became a runner in my early 30s, and even now, I run at least 6 miles every morning.

WCR: Do you run every day? That's 42 miles a week.

CRB: My wife and I run around White Rock Lake on Sundays. That's our special treat together. That's 9 miles or so.

WCR: I gather you were quite a good student in junior high and high school. It sounds like school came rather easy for you, except for the reading problems, which you overcame.

CRB: The reading part was a struggle, but the rest was easy. I was one of the top students in my class. Because I was born in 1947, the beginning of the bulge of the Baby Boom, my 10th-grade class was bigger than the 11th and 12th grades put together.

WCR: How big was the high school?

CRB: There were 351 in my high school graduating class. We had some kids from farms and some kids from Endwell. I was fully grown before I realized that there was a little pun in “all's well that ends well.” It didn't occur to me when I was younger. It must have had to do with my linguistic limitations.

WCR: When you were growing up, did you go on family vacations?

CRB: Yes. In the 1950s we typically vacationed for 2 weeks at the New Jersey shore with my father's family. Later, when I was an adolescent, we went with friends from our hometown to Cape Cod. We'd rent a cottage, go to the beach to swim and sail, and dig clams for dinner. We had wonderful times together. The family was very close. It was a great time because we really got to spend time with Dad for a change. We offspring always looked forward to those times.

WCR: It sounds like your home was very pleasant and everybody was happy. There was not a lot of fussing, arguing, judging, and so on.

CRB: Right. I had a Catholic father and a Protestant mother. There was never an issue of religious intolerance at home. It spilled over into other things too. There was a general atmosphere of tolerance.

WCR: Did you go to the Catholic church?

CRB: Yes. We went to a Catholic church on Sundays. Part of the curiosity about growing up in my home was that we were Catholics on Sunday, but Mother ruled the roost the rest of the week. I have a feeling that we were at least partly Protestant during the rest of the week. My two sisters married Catholics, and they continue with that. My little brother is in a position of leadership in his Protestant church, and although I'm not especially religious, I am married to a good Catholic.

WCR: Were you tops in your high school graduating class?

CRB: No. There was one student who was always better than everyone. He went to Princeton. I was probably the Second-best student in my class. No one was going to beat the number-one student. He was a star.

WCR: How did you decide to go to the University of Notre Dame?

CRB: A friend of the family had gone to Notre Dame. My sister's boyfriend was going to Duke. So, I applied to Notre Dame and Duke. I also applied to Cornell because it was nearby. I was accepted by Notre Dame and Duke. My dad asked where I wanted to go. I told him, “I think I'll go to Duke.” He said, “Why don't you think about it a little bit longer?” He came back the next day asking, “Where do you want to go?” I told him, “Duke.” (Duke and Notre Dame are both beautiful, gothic-looking places.) One day I said, “I think maybe I'll go to Notre Dame,” and he said, “You thought about it enough.” He came from an Irish Catholic family, and he was the first generation to go to college at all. For me to go to Notre Dame was like the grandest thing he could imagine. I went to Notre Dame (Figure 7).

Figure 7.

At age 21 upon graduation from Notre Dame, 1969.

WCR: What did you major in at Notre Dame?

CRB: Notre Dame had a premed major. If you enrolled in the school of science, you could be premed. They started off with about 400 premed students. They whittled it down to about 100. After a year or two, you could transfer into the school of liberal arts and still be premed if you met certain grade requirements. I transferred after my sopho more year because I needed more work in that area. It probably looked like I was a science major when my transcript went in, but actually I was in the school of liberal arts.

WCR: Were there teachers in junior high, high school, or college who had a major impact on you?

CRB: Yes. The best teacher was my high school biology teacher, Tom Jones, a wonderful guy. He taught descriptive biology in the 10th grade and then left to get more education when I was in 11th grade. When he came back, he was interested in DNA and biochemistry. When I took advanced-placement biology in 12th grade, he turned me on to understanding more about how cells work and what biochemistry was all about. My best friend, Scott Davis, and I did a science project with rats. My mother took me to the humane society. I would get a dead cat, bring it home, and dissect it; one time I even reassembled the bones. I won the local science fair with that. I was always curious about how animals functioned and what was inside them. Some people might have found it interesting to find out what's inside a radio. I always wanted to know what was inside a living organism. Any animal that died in my yard ended up on my dissection block. I got formaldehyde and saved organs to show my friends.

WCR: That was in high school?

CRB: It actually started in junior high school. For Christmas, when I was about 13 years old, my father gave me a microscope and a dissecting kit. It's the only Christmas I can remember exactly what I got. Those were the best gifts.

WCR: Notre Dame in South Bend, Indiana, was how far from your home?

CRB: It was 850 miles.

WCR: How did you get there?

CRB: We drove 80 miles to Syracuse and then went to South Bend by train.

WCR: You didn't come home but once or twice a year.

CRB: I came home for Christmas and Easter breaks.

WCR: You started college in 1965. How many students were at Notre Dame at that time?

CRB: Sixteen hundred students in my starting class and about 6000 students on the whole campus.

WCR: When you graduated, you were magna cum laude. What does that mean at Notre Dame?

CRB: I think that meant that your grade-point average was >3.5 out of 4.1 probably had the top grade-point average among the liberal arts premed students. They'd post the grades each year. There were no 4.0 students, as there was not a lot of grade inflation then. They wouldn't allow me to place out of Biology 15/16, which was what a science student had to take, but it wasn't as good as my high school course. They graded on a bell-shaped curve. There were 220 students taking the biology class sophomore year. On the first test, they gave 12 A's, 20 B's, and about 150 C's. One guy who didn't do so well on that first test was Eric Weischaus, who later won the Nobel Prize for medicine or physiology for his work in embryogenesis with fruit flies. Another guy got a PhD from Yale in biology, and he had problems with the first test. The grading was pretty rough. Notre Dame was an interesting place because many of the students came from middle-class or blue-collar households and worked very hard to be upwardly mobile. They wanted to end up in a better situation than they came from. It wasn't a place where the gentrified went in great numbers. The Kennedys didn't send their kids to Notre Dame. They wanted them to go to Harvard.

WCR: Blue bloods don't go to Notre Dame. Did you have to study hard at Notre Dame, or did the grades come fairly easy for you?

CRB: I thought it was going to be easy. I went there brimming with confidence that I would do well. Then I didn't do very well on the first chemistry test. I had to take freshman theology, but I hadn't gone to Catholic schools and hadn't gotten a lot of the Catholic theology at home. I realized that I had better work a lot harder, but I loved it.

I really enjoyed being a student. I spent a lot of time in the library, getting lost in the stacks. I'd start working on a paper, and then I'd find a book or an article I was curious about and read that instead. At the last minute I would realize that I had frittered away all of my time reading stuff that was interesting to me, but I still had to write that paper. I'd write a paper furiously the last evening before it was due. I'd fill myself with a lot of stuff that was very interesting to me. Notre Dame was fun. I made good friends. I felt a little cloistered since it was an all-male institution at that time.

WCR: Where did you go to meet girls?

CRB: St. Mary's College, a girls-college, was across the street, but there were five guys for every girl. Crossing the street was usually a nonfruitful venture. Notre Dame went coed a couple of years after I graduated.

WCR: What did you do in the summertime when you were in college?

CRB: I had a union card in the Laborers Union, and I worked on construction for 5 summers. I was a mason tender.

WCR: Back home?

CRB: Yes. I built scaffolding, shoveled mortar, and carried cinder blocks and bricks.

WCR: You made most of your spending money from your summer job?

CRB: Yes. The family was comfortable, but my father would never see it that way, coming from a poor family himself. I think he saw it as a moral issue that his children fend for themselves and get their own spending money. I never went to my father for money.

WCR: What did your mother do after your father died? Did she marry again?

WCR: She did. A year after my father died, she married a man who had been a friend of the family. They moved to south Florida. That was when the innkeeper part came back because the two of them bought and ran a small hotel in Fort Lauderdale. Unfortunately, my stepfather died of a heart attack about 2 years after they married. So, at 50, she was widowed a second time. She was a self-reliant person and kept the hotel for a while. Then she bought a condominium. She continued to have attentive boyfriends. She was never one to not have a man around; she attracted them easily.

WCR: Is your mother still alive?

CRB: No. That's a sad story. When she was 66, she began to get a number of odd symptoms. She got blotchy patches on her skin and suddenly developed hypertension and diabetes mellitus. Her local doctors in Florida couldn't figure it out. I was at the University of Michigan at the time and told her to come to Ann Arbor. She arrived and I figured out, on the way home from the airport, that she had Cushing's syndrome. Unfortunately, this was due to an adrenal cancer. She died after an IS-month illness.

WCR: Your mother was born in what year?

CRB: In 1923, and she died in 1991.

WCR: And your father?

CRB: He was born in 1921 and died in 1970.

WCR: It sounds like you decided you wanted to be a physician very early in your life.

CRB: I was probably 5 years old when I got that in my head. Early on, it was not a carefully thought-out decision. I wanted to be like my father; to me he seemed to be the most important guy in the world, other than the president maybe. There wasn't anything in between. It became clear early on that I probably was going to have the aptitude to pursue medicine. I never wanted to do anything else. When I went to college I met with the guidance counselor. He asked me what I wanted to do. I told him, “Oh, I'm going to be a doctor.” He said, “That's pretty hard. Also, you come from New York State, and medical schools tend to have quotas on how many students they'll take from each state. More people from New York want to be doctors than from any other state. You might not get into medical school.” I told him, “Oh yes, I will.”

WCR: Did your brother have any leanings towards science?

CRB: He may have been a better student than I was, and he was a biology major at Cornell. He was closer to my father than I was, since he was the last one to leave home for college. As my brother became a star athlete, both in track and swimming, he and my father bonded very closely. My father's death was harder on him than it was on any of the rest of us, I think. He was a first-year student in college when our father died. I think he briefly lost his drive and motivation. He got it back and then got a master's degree in pharmacology and went into the pharmaceutical industry. He started as a pharmaceutical representative and worked his way up. He became an executive with Bristol-Myers Squibb and was the director of the international sales force for some time. He left Bristol-Myers Squibb after 25 years and is now with a new start-up pharmaceutical company. Of course, we all attribute his success in life to his wife, Nancy.

WCR: All siblings have done well?

CRB: Everybody has done fine.

WCR: When it came time to choose medical school, did you apply to several medical schools? How did you choose Yale?

CRB: For starters, I asked my father, but he didn't have any suggestions. He was a member of the first generation of his family to attend college. I don't know how my father ended up at Georgetown Medical School, but my guess is that he didn't apply anyplace else. Because of the war, medical students were drafted, and they put the physicians through medical school in 3 years. I applied to Georgetown because that's where he had gone. Then I went to see the premed advisor and he took a look at how I'd done. I had done very well on my Medical College Admission Test. He told me I should apply to Yale and gave me their catalog. I didn't even know where Yale was. I asked him, “Is it a good place?” He told me it was. Yale had an unstructured teaching curriculum with no tests. It also had a thesis requirement, which I thought would be interesting.

I only got around to applying to Georgetown and Yale. I flew to Georgetown and interviewed there, and a week later I got accepted by them. I called my dad to tell him I'd been accepted at Georgetown. He asked, “Are you going to go?” I told him I wanted to hear from Yale first, although I hadn't visited it. (I don't think I had even been to the state of Connecticut!) Then, I interviewed in Indianapolis for Yale, and a week later I got an acceptance. There was a slight difference in the tuition costs: Georgetown was $1650 a year and Yale was $2200. Now I had these two acceptances in hand, so I called my father to tell him about Yale. He said, “Where are you going to go? Are you going to go to Georgetown?” I said, “Can the family afford to send me to Yale?” He paused, “Well, yes.” I asked, “May I go to Yale?” He quietly acquiesced and let me go to Yale. The first day I saw Yale was the day I showed up for classes. I got off the freeway and asked someone on the street, “How do you get to Yale?” They told me to go down the street. There I was.

WCR: Were there any surprises when you started medical school at Yale?

CRB: Yes. Everybody there was very accomplished and ambitious. Most of the students at my high school didn't aspire to go to college. Under those circumstances, it was easy to get a little distance between the pack and me. I had done well in college. In medical school, everyone had been previously successful, and it was a bit intimidating at first. Of course, none of them were shy to share their tales of successes. They were all quite proud of their accomplishments. There were 85 students, 77 men and 8 women. There was also culture shock because about a third of the students came from the greater New York City area and I came from upstate. The Midwest starts at the Hudson River! I was really a midwesterner and didn't know it until I got to New Haven.

WCR: This was the first time you'd seen a lot of students who had gone to Harvard or Princeton or Yale?

CRB: It's funny that you should say that. We had one student from Harvard and none from Princeton. We had 17 from Yale. Five were from Notre Dame. Someone suggested that there must have been some sort of affirmative action program going on for Notre Dame.

WCR: From a medical standpoint were there surprises?

CRB: First of all, I loved it. I enjoyed every lecture and the anatomy dissections. What surprised me was how little we knew in the medical sciences. Most diseases I heard about had unknown causes, and there were no effective treatments for them. Yale was a perfect match for me because I didn't need tests to learn. Essentially what I did was read the books to the degree that I would know where the information was. I made no attempt to memorize much of anything. As long as I knew where the information was, I could find it when I needed to know more about it, which permitted greater depth in the things that interested me. In medical school I did not study all of the various pathways in biochemistry. During my fellowship several years later, I was in a biochemistry laboratory where I learned the necessary details about biochemistry.

Yale was an excellent preparation for an academic career, which was what Yale specialized in. The clinical training may not have been as good as that in most state schools, in fact. There was less emphasis on the practical than on the theory of disease and treatment. We had a number of notable academics from my class. Two department chairmen at the University of Texas Southwestern Medical School were from my class: George Lister is chairman of pediatrics and Bob Bucholz is chairman of orthopaedics. Lee Goldman is chair of medicine at UCSF. Jerry Rosenbaum is chairman of psychiatry at Massachusetts General Hospital, David Bailey was chairman of pathology at UCSD (and interim dean when I was there), and Rick Young is chairman of pediatrics at St. Raphael's in New Haven. There were numerous division chiefs too.

WCR: I gather that you were tested after your second year and at the end of your senior year?

CRB: We had to pass parts 1 and 2 of the National Boards and turn in an approved thesis.

WCR: As you went through the classes, and particularly when you got into the clinical rotations, was it pretty clear to you that you wanted to be an internist?

CRB: When I started medical school, I thought I wanted to be a surgeon because I thought they did the most interesting work. When I got to medical school, surgical training seemed to be dominated by hierarchy and following orders, whereas medicine, in particular although not exclusively, seemed to be focused upon problem solving. Back in those days, a person with hyperthyroidism or with a new onset of hypertension would be in the hospital for several days. I'd get to know the patients and think about them. I enjoyed that and recognized it was the right thing for my style of thinking.

WCR: Were there any particular faculty at Yale Medical School who really had an impact on you?

CRB: Yes, there were three in particular. One was Louis Thomas, who wrote the essays in Notes of a Biology Watcher. He was at Yale at that time and later became its dean. He was a professor of pathology, but I don't think he ever trained as a pathologist. That was not unusual for Yale, and many professors were there because of their research interests. He was the teacher for a group of eight medical students, including me, in microscopic pathology, about which I think he knew very little. We brought our microscopes and got a box of 100 slides. If we had an inflammation laboratory, we'd have 2 hours to look at acute and chronic inflammation of every organ. He'd take a slide and say, “Take a look at this. That's acute inflammation. All other acutely inflamed organs look this way.” Then he'd show us chronic inflammation and say, “These are chronic inflammatory cells. That's the way it looks in all organs, and this is boring.” Then he'd start talking about experimental pathology and how key problems were solved. He would ask, “How would you solve this problem? What do you think made this happen?” His sessions were wonderfully stimulating. I'd go away from there with my mind churned up and wanting to chew on some more problems. In his lecture on cancer, which was one of the most memorable ones, he discussed cancer in a philosophical way. He talked about how cancer might develop. Of course, no one knew how cancers occurred at that point. I found the theories he discussed to be very interesting. My mind was getting cranked up to think about cancer at that time because of my family experience. He clearly impacted me.

Another was Leon Rosenberg, who also became a dean later. He had a great class on clinical correlations with biochemistry. He would bring a patient in with a renal stone like a uric acid stone. The patient would tell about his flank pain and his bloody urine and provide colorful details about how he passed a stone. By that time all the students wanted to know where the stone came from and why some people made too much uric acid. It was a really interesting way to learn biochemistry. Then Dr. Rosenberg gave us a notebook with all the biochemical pathways in it. You could see the way purines are made and how they were degraded. It wasn't important that we knew the names of each enzyme, but we got a sense of the big picture. I learned that there were people who got sick and there were biochemical pathways, and the two were linked. That was very satisfying to me. He also reminded us that one of the syndromes we studied was named after the medical student who shared in its discovery. So, he laid down a challenge too.

The third one was Jim Boyer, who was my first clinical teacher. He was a hepatologist. He got me interested in liver disease and gastroenterology. When I was a first-year student, he would take us to a chart and tell us what all the abbreviations in the chart meant. I've kept in touch with him since then. For a brief time, I thought I might want to be a hepatologist, probably because of his influence. He was the first one I went to when I learned about my father's colonic cancer. I had been told that the cancer had spread to his liver. I asked Jim, “What can you do about cancer when it's in the liver?” He put his hand on my shoulder and said, “There's nothing that can be done.” That was in 1969. Liver metastases were death sentences then.

WCR: There was another famous hepatologist at Yale?

CRB: Yes. Gerry Klatskin. He insisted that medical students who wanted an elective in hepatology had to do 8 weeks of it. So I did 8 weeks. It was my fourth year, so I spent half the time writing my thesis. Gerry Klatskin was the attending for one of those months. He had enormous stature in hepatology and was one of the originators of the field.

WCR: Was Paul Beeson still there or was Phil Bondy chairman of medicine?

CRB: Beeson had left before I arrived. There were three chairman of medicine when I was at Yale. Bondy was there my first year and went on sabbatical. Then we had an interim chairman; I think it may have been Franklin Epstein. Epstein left when he wasn't picked to be the new chairman, and, finally, Louis Welt was the chairman of medicine in my fourth year of medical school.

WCR: In summary, your medical school experience was great.

CRB: I loved medical school. It taught me how to continue to learn. I'd say that most of the lectures I heard were terrific. I'd take extensive notes. I still have the notes, but I don't go back and look at them. It is likely that I've learned more since leaving school than when I was there.

WCR: How did you decide to go to St. Francis Hospital in Hartford, Connecticut, for internship?

CRB: Having applied to only two medical schools and being in the upper part of my medical school class based upon my National Board scores, I figured I didn't have to apply to very many internship programs. During my fourth year of medical school, I had gotten a Public Health Service scholarship because I was out of money. I had been in medical school for only 2 months when my father had to retire from practice because of his illness. My younger sister at that point still had 2 more years of school at Syracuse and my brother had just started at Cornell. My mother told me, “I can't afford to send all of you to school.” There was no income for the family at that time. I went to the dean of students, and he gave me a scholarship for my sophomore year. The next year I was given loans, and the last year I got the Public Health Service scholarship. For that support, I agreed to go to the Indian Health Service immediately after internship. I was unaware that this was not going to be received well by medical training program directors. The draft was over so there were no 1-year programs. During interviews, I told them I planned to leave after 1 year, and as a consequence I did not match. On match day the dean of students called and said, “You aren't going to any of those places.” I had to scramble at the last minute. A former Yale pulmonologist had recently become the chairman of medicine at St. Francis Hospital in Hartford, so I took his offer to join his program. I was mightily disappointed at the time, but it turned out to be a fine training program.

WCR: Where had you applied for internship?

CRB: I applied at San Francisco General Hospital (where everyone wanted to go) and the University of Rochester, which at that time was another very popular place, and a couple of other places.

WCR: Your Public Health Service work was in New Mexico. Where is Gallup?

CRB: Gallup is on the New Mexico/Arizona border on Interstate 40.1 had gone to New Mexico for 8 weeks in the summer between my first and second years in medical school. They had a summer program there that was in large part a recruitment program. I was enchanted with the geography. I was a product of the 1960s where helping one's fellow man was very important. Because of the war in Vietnam, there was a turning away from doing service overseas. I didn't see myself going to a third-world country to do good work when we had problems in our own country. My feeling was that I had to do my good deeds in the USA, and the Native American population seemed to be ideal because they had such meager access to medical care. I requested specifically to go back to Gallup and to the same hospital where I had been after my first year of medical school. I was a general medical officer for 2 years.

WCR: You didn't apply to the National Institutes of Health (NIH) or the Centers for Disease Control and Prevention?

CRB: No. At that point, I was still laboring under the assumption that I would not live to be an old man and that I had to quickly get my licks in on earth.

WCR: A general practitioner in the Indian Health Service meant what? Did you deliver babies, for example?

CRB: Yes, quite a few in fact. As was typical for Yale, I had a 3-week rotation in obstetrics, during which time I touched six babies but was responsible for none of the labors or deliveries. The idea was that students would learn the more esoteric aspects of fetal monitoring but wouldn't necessarily deliver a baby. I went to the chairman of obstetrics during my fourth year and asked if I could take a 1-month rotation and deliver some babies. He refused. He said, “That's too simple. They'll teach you how to do that in the Indian Health Service, but if you want to learn fetal monitoring, I'll let you do a clerkship.” I told him I didn't want to do that. Ironically, when I went to Gallup, my first rotation was in obstetrics. We hadn't unpacked our boxes, and a guy came over and said, “I'll see you tomorrow morning on the obstetrics ward.” They taught me how to deliver babies, of course, on the first day. The irony was that just as I arrived, they were getting their new fetal monitors in place. So, I immediately learned to use fetal monitors. Who knew?

WCR: Did you do some surgery in Gallup?

CRB: Yes. As a general medical officer, I assisted fully trained surgeons. I did the deliveries on my own, and I did 25 cesarean sections—with an obstetrician on the other side of the table. Cesarean sections are not hard; they involve just two incisions. I assisted on excisions of the gallbladder and appendix. I also removed a lot of toenails and did much suturing for trauma.

WCR: You must have felt that after those 2 years you were a real doctor and there weren't a lot of things you couldn't handle.

CRB: When I started medical school, I was going to be a practitioner. That was all I thought about. In fact, I didn't know that physicians did research; I thought that PhDs did research and physicians took care of patients. (Some people still think that.) By my fourth year of medical school, however, I began to think about trying to solve the problem of colon cancer. I also thought a bit about being an academic hepatologist because I enjoyed Gerry Klatskin, Jim Boyer, and the faculty in the liver unit at Yale. That was tempting. When I was in the Indian Health Service, we saw a lot of liver disease: many gallstones, a little viral hepatitis, and a lot of alcoholic liver disease. I always had this need to be a competent clinician because my father was. There was his standard to match. I think if I hadn't done that, I would have felt very incomplete. Once I finished my internal medicine training, I felt I could do anything I wanted. That was when I began to take a more mature approach to the rest of my life and decided to do research. I don't think I could have gone to the NIH and felt comfortable with my career as a physician.

WCR: After your 2 years in New Mexico, you went to San Francisco to finish your residency in internal medicine.

CRB: A lot of people were coming out of the military service having been on the Berry Plan. No one was leaving medical residency programs, and few were getting back into programs they had left during the Vietnam War era. I was offered an opportunity to come back to Connecticut, and I almost did. The chairman of medicine at St. Francis was Dr. Steve Sulavik, and I liked him a lot. He took a real interest in me because he realized that I ended up in his hospital by accident. He took me aside one day during internship and said, “You know, Rick, you ought to think about academic medicine. I think you are going to be very bored if you elect to do full-time clinical practice.” So, when I visited St. Francis in 1975, he told me, “We have a position for you here.” He wanted me to sign on the line. I said, “I want to find out whether there might be a position in San Francisco.”

The 1960s were just behind us, and there was a great attraction to go to San Francisco. It was where all the love and happiness was. (I won't tell you how long my hair was at that time.) I called Lee Goldman, who was a houseofficer at UCSF. He looked around a bit and said, “There isn't anything available here.” With some additional probing, I heard there was a Public Health Service hospital in San Francisco, and against all hope, I thought there might be a position there. It just so happened that they had four medicine interns and no empty slots. Then fate intervened. The hospital had decided that the houseofficers would be required to wear uniforms. The interns said they wouldn't, and all four were fired. So, shortly after I called, the chairman of medicine offered me a residency position. He asked if I minded wearing a uniform, and I replied, “No, sir.” This gave me a wonderful opportunity to be a houseofficer at the Public Health Service hospital. I saw patients with leprosy, Native Americans, merchant marines, and travelers who came in on the ships with weird infectious diseases. It was a great residency, plus I did all my electives at UCSF.

WCR: They got to know you at UCSF, so when it was time to apply for your fellowship, they knew who you were.

CRB: Exactly.

WCR: During your residency you must have decided on gastroenterology as your subspecialty fairly quickly.

CRB: Yes. I was given my own office while I was a resident at the Public Health Service and had it for 2 years. It was next to the office of the chief of gastroenterology, Mark Rosenberg, so we got to know each other very well. I was certain from the time that I was in the Indian Health Service that I was going into gastroenterology. It was when I was in San Francisco that I began to think seriously about what I ought to do with my life. That was when I decided to study colon cancer.In fact,the first big goal I set for myself was to learn more about colon cancer than anyone else on earth.

WCR: Was your fellowship 2 or 3 years?

CRB: A standard gastroenterology fellowship then was 2 years, but I did 3 years, which was standard for those who chose a laboratory experience. Since I'd had those 2 years in the Indian Health Service, I didn't really need the full 2 years of residency. The last 3 months of my residency in San Francisco, I did all gastroenterology. I did 6 weeks at UCSF and 6 weeks at the Public Health Service hospital. By the time I started my fellowship, I knew how to perform upper endoscopy and colonoscopy. I had come over from the Public Health Service hospital, but the other fellows had come from university programs. The chief of gastroenterology at San Francisco General Hospital, John Cello, looked me over pretty carefully to make sure that I wasn't defective material. However, at the end of the first year he asked me if I would come back to San Francisco General and take a faculty position there when my training was finished.

After 1 year of clinical training, I went into the lab and didn't do any of the advanced endoscopy, such as endoscopic retrograde cholangiopancreatography. In my second year, I walked into a basic science laboratory that was focused on glycoprotein biochemistry. The head of the lab was Young Kim, MD, who had one of the largest colon cancer grants in the country and was one of the country's premier colon cancer researchers (Figure 8). He was working on cell membrane glycoproteins. I had no idea if these glycoproteins would lead me down the pathway to understand familial colon cancer. I decided 1) to learn everything about clinical colon cancer, 2) to learn everything I could about how to do research, and 3) to have faith that some day these things would take me to the answers of hereditary colon cancer. The glycoproteins were a means to an end initially. There was no good rational reason to believe it; it was a matter of faith.

Figure 8.

With his two academic mentors. Young S. Kim, MD (left) and Marvin H. Sleisenger, MD (right), in San Francisco, 2000.

WCR: That's a great story. You got married when you were at Yale Medical School. Whom did you marry?

CRB: Well, that's a great story too. I married a woman who lived about a half mile away from me in Endwell, New York, but we never met until we were in college. She went to Catholic grade school and high school and then to a Catholic girls' college. Of course, I was going to a Catholic boys' college. Her family had a cottage next door to the summer cottage of my friend Scott Davis—the one with whom I did the rat experiments in high school. I met Pat briefly at a New Year's Eve party in 1965, but we didn't date until the summer of 1966, after my sophomore year in college and her freshman year. I am 1 year older. We dated for 3 years. She was the only girl I ever wanted to marry. She was the one!

WCR: What characteristics initially attracted you to her and convinced you that you wanted to marry her?

CRB: Her intelligence and her focus on what was right in life. She's a remarkable person. She is the most ethical person I know and one of the most disciplined. She always does the right thing. She never seems to waiver from staying on the right path.

WCR: What is her name?

CRB: Patricia Sweeney.

WCR: Do you have children?

CRB: We have three daughters (Figure 9), and they all have Sweeney for their middle name, so they are all Sweeney-Boland. We married right after my father died.

Figure 9.

Maureen, Brigid, and Tara, 2003.

WCR: That was during your freshman year of medical school?

CRB: During the summer of 1970, my father was failing. Pat and I had talked about marrying, but I was a medical student. I saw marriage as something that we would do in a few years. She was a public health nurse and had gotten her first job in Mamaroneck, New York, which is about an hour from New Haven. My father was very fond of Pat. He was near death and I said, “Let's tell Dad that we plan to get married.” We knew that we were destined for each other, although we didn't think it should happen quite that soon. When we told my father in mid July, he asked “When?” We rather spontaneously told him we would marry at the end of the summer. He died on July 26. The whole family was there for his funeral and we said we guessed that we would delay the wedding. My aunt Pat Jones, my mother's sister, asked, “Well, why wait?” (She was fond of Pat too.) We ended up getting married on September 4, over the Labor Day holiday. We were married just before I started my second year of medical school (Figure 10). Nobody in my class had a clue that I was going to be getting married. I came back from the summer and was married. Someone asked, “What did you do over the summer?” I answered, “My father died and I got married. How about you?” It was quite a memorable summer in 1970.

Figure 10.

Marrying Patricia Sweeney at the Sweeney family cottage. Forest Lake, Pennsylvania, September 1970.

WCR: After you finished your fellowship in gastroenterology in San Francisco, you were offered a position to stay?

CRB: Yes. At the end of my fellowship I was offered a faculty position beginning in July 1981. Of course, there was no salary associated with it. It wasn't until April 1981 that I found out whether I'd get paid anything, and I was a bit worried. In May 1981 my third daughter was born. I was in a pretty precarious situation, but I got an NIH grant funded and a research award from the VA. The very first series of experiments I did was very successful. I discovered a type of tumor marker and differentiation marker for the colon that was quite novel in concept. My first paper was published in Proceedings of the National Academy of Sciences and has been cited about 300 to 400 times.

WCR: How did the University of Michigan move come about?

CRB: At UCSF it appeared I was going to be on soft (i.e., grant) money in perpetuity. The division had about 30 members, and there were three stable faculty salaries. They had only three state-funded positions! The VA had its own independent positions, but these were held by people who had been there for a long time and who seemed to have no interest in leaving. I was at the end of my 3-year Research Assistant award. The San Francisco VA Hospital was the premier research institution of all the VA hospitals inasmuch as we had more career development award holders than any other VA hospital. An official came from Washington, DC, and said to our group, “This is a steeply pyramidal system, and all of you aren't going to be able to go to the next step.” The chairman of medicine had come by one time and said, “It's unfortunate that we can't keep all of you on here, but a lot of medical schools would love to have you.” In the midst of all this I was applying for the next step in the VA career development pathway, and my NIH grant was up for renewal as well.

I had become a jogger by this time, and I used to jog with others at the gastroenterology meetings. One was Tachi Yamada, who had just left the University of California at Los Angeles to become chief of gastroenterology at the University of Michigan. He came up to me at a meeting in November 1983 and asked me how things were going. I said that everything was going great. As far as I could see, that was the way it was. Work was coming along well. I was publishing articles. He said, “I've got a job for you.” I told him I didn't need a job; I had a job in San Francisco. He said, “How many children do you have?” I told him I had three. He said, “Are you going to raise them in San Francisco?” I said, “Probably not. I think it's too expensive.” He said, “You ought to come to Ann Arbor. It a great place to raise a family.” He asked me to send him my curriculum vitae. I went home but did not send it. He called me up a week or so later and reminded me. I said, “If I sent you my curriculum vitae it would imply that I would want to come out and take a look.” He told me he wanted me to take a look. I told him I didn't want to travel because I was already traveling too much (probably once every 3 to 4 months). I kept making excuses, but to make a long story short, he finally invited my wife to come and even paid for the babysitters in San Francisco. He recruited me from San Francisco to Ann Arbor, Michigan, in December. It was very cold. You can imagine how magnetic he had to be to pull this off. But, it was clear to me that Tachi was going places and, in fact, he ultimately became one of the most influential figures in academic gastroenterology. He became the chairman of medicine at the University of Michigan, edited The Yamada Textbook of Medicine, and now is the director of research and development for GlaxoSmithKline. I could see that this was a guy on the move, and I decided Michigan was the place to be. I went to Ann Arbor and became chief of gastroenterology at the Ann Arbor VA Hospital 3 years out of my fellowship.

WCR: That was a great VA. Bob Vogel and John Mancini were there at the time?

CRB: Yes. We loved Ann Arbor. My kids have their warmest memories of Ann Arbor, although two of the three now live in San Francisco. Ann Arbor is where my two oldest girls grew up and graduated from high school. It's an ideal family town (Figure 11).

Figure 11.

Pat, Rick, Brigid, Maureen, and Tara in November 1991.

WCR: Ann Arbor itself has how many people?

CRB: About 125,000.

WCR: How many students are at the University of Michigan?

CRB: Forty thousand or so.

WCR: That's one of the great medical centers in the country.

CRB: Bill Kelley was the chairman of medicine, and he was a dynamo. He brought a most remarkable collection of investigators into the department of medicine and the Howard Hughes Institute. They have all been successful.

My research career underwent an important change in direction while I was there. I continued to do the glycoprotein biochemistry research that I'd been doing in San Francisco. However, articles came out in the summer of 1987 showing that there were mutated oncogenes in many colon cancers. In 1988 to 1990, several groups, but particularly a group from Johns Hopkins, began to show that colon cancer was driven by mutated genes and that there was sequential multistep carcinogenesis in the colon. I realized that the glycoproteins had served their purpose for me. I had to get into the genetics of colon cancer or I was going to be left behind. Plus, I soon discovered that it was the only way to understand familial colon cancer.

In 1990 I did a 6-inonth sabbatical with Andy Feinberg at the Howard Hughes Institute in Ann Arbor. He had come from Johns Hopkins and was the first postdoctoral fellow of Bert Vogelstein. (I predict that Vogelstein will win the Nobel Prize one of these years.) These two guys put together some remarkable papers in the 1980s. Working with Andy, I learned tumor genetics and procedures for DNA extractions, polymerase chain reaction (PCR), Northern blots, and Southern blots, which were essential for changing the direction of my lab. We were trying to refine the concept of multistep carcinogenesis. I was a fairly experienced histochemist by then, and I found out that I could take tiny pieces of tissue from paraffin-embedded tissue sections, use PCR, and find out precisely what genes were mutated in a very well-defined tissue microdomain; no one else had published this approach yet. To attack the problem, I eventually had to use PCR to amplify DNA sequences called microsatellites. That work proved to be fortuitous. Depending on your perspective in life, you can see it as very good luck or providence. It turned out that microsatellite mutations were the key to understanding familial colon cancer, and I was ahead of anybody else in gastroenterology studying this problem. Within months of the first discoveries, my laboratory developed the first in vitro models of hereditary colon cancer. A few years after that, we cloned the gene that caused cancer in my father.

WCR: What a story!

CRB: Persistence had paid off. And I had a wife who never gave me a hard time for having these wild dreams of knowing everything there was to know about colon cancer and wanting to solve this problem.

WCR: What was your work schedule like when in the midst of these incredible discoveries? What time were you getting up in the morning? What time did you get to the lab or the hospital?

CRB: I was pretty regimented about these things. Tachi Yamada and I lived next door to each other. I woke at 5:30 AM. We'd meet in the driveway at 5:50 AM and run 8.5 to 9 miles every morning during the week. It took 65 to 70 minutes. We ran about 7.5-ininute miles. I'd run longer on weekends. There were some great back roads running between farms. I was at the lab by 8:00 AM and worked to about 7:30 or 8:00 PM. I worked Saturdays and a lot of Sundays too, which may have not been the wisest activity for family life but allowed me to get a lot done. I wish I had some of those Saturdays and Sundays back to spend with my wife and daughters.

WCR: After dinner at night, did you usually continue working?

CRB: Yes. I brought home articles to read in the evenings. I did not write at night.

WCR: What time did you go to bed?

CRB: Midnight or 12:30 AM.

WCR: Five hours of sleep was enough for you?

CRB: Yes, but on Sundays, I'd take a long nap.

WCR: Do you need more sleep now?

CRB: No. Now, I go to bed about 11:30 PM and get up at 5:00 AM and do a few extra things around the house.

WCR: Do you still run?

CRB: I can't run 8 to 10 miles every day anymore. Like all runners, I've suffered a series of injuries. I can run only 6 miles now, but I run a little longer on the weekends just for fun.

WCR: Does your wife run with you?

CRB: Yes. She is a remarkable runner (Figure 12). When we grew up in the 1950s and 1960s, there were no athletic outlets for her in school. She was a cheerleader in high school. In the mid 1980s she began jogging on her own. Six years after we moved to Ann Arbor, my neighbor Tachi moved across town to a bigger house. So, Pat and I began to jog together. When we ran competitively, we ran essentially the same pace, so when we were in a race, I'd finish in the middle of the pack of men, and she'd clobber all the women. She has won 10-kilometer races in which there were as many as 2000 runners competing. She won trophies and even lost her amateur status—she won prize money. She's a tremendous athlete and didn't realize it until she was almost 40!

Figure 12.

Rick, Pat, their three daughters. Bill Reckord (Pat's uncle), and family dog after the Dexter to Ann Arbor Run, 1988. Pat won the women's master division race that day.

WCR: How did you get attracted away from Ann Arbor? It sounds like you were in an ideal situation there.

CRB: It really was. I got the bug, I guess. I decided that I wanted to be a division chief. Tachi was a really good friend. He wanted me to stay at Michigan, but he also would give my name to other institutions looking for a chief. I had a folder with 20 or 30 letters of invitation to interview for one job or another to be division chief. (Lots of people get these letters. It's nothing special.) I almost always declined the invitation, but in 1990, I looked at the University of Rochester. They wanted me to take that job. But, when it was offered, Tachi (who had initially given my name to them) turned around and gave me a new laboratory and a recruitment package to stay. By the mid 1990s, I realized that Tachi was not going to stay at the University of Michigan much longer; he had grander aspirations. He had joined the board of directors for SmithKline Beecham and was already the chairman of medicine at Michigan. I figured he would probably go for bigger and better things, and I thought that eventually the Camelot would break up. As a humorous diversion when we used to jog together, I once sang “Camelot” to him. When I realized he wanted to become chairman of medicine and was being offered various positions, I told him, “You're going to break up Camelot.” My colleagues from Ann Arbor still look back fondly to our Camelot.

I got a letter of invitation to look at UCSD and sent back the “no thanks” letter. Their initial search failed to get the person they were looking for, so the chairman of medicine called me. He said, “Why don't you come out here and take a look. We think this would be a good job for you.” I said, “I think you have a lot of problems there and I'm not so sure.” We discussed the problems—managed care, competition for patients in San Diego, and the split campus; everybody knew the challenges they faced. I spoke with Tachi and Chung Owyang, who had taken Tachi's place at Michigan, and they both advised me not to go there. In October 1994,1 told him I wasn't coming, but he convinced me to take a look. I told him that because of other commitments, I'd come at the end of January. I also told him if he found someone else that was fine. Ultimately, I went out there and fell in love with San Diego. It's an enchanting place, especially when you fly in from Michigan in January. I convinced myself that I could overcome the USCD problems. There were frustrating times, but actually it was a lot of fun. I enjoyed it like all the other things that I've done. There were some superb scientists there, and I made some good friends.

WCR: You were there for how long?

CRB: I was there from 1995 to 2003—almost 9 years.

WCR: How did you like being chief of the division? How many fellows and staff did you have?

CRB: We had about 20 faculty and 5 or 6 fellows. The faculty were very committed to the academic mission, and working with fellows is rewarding. I also watched some excellent junior faculty grow and flourish.

WCR: When you count all the secretaries and lab technicians, how many people did you deal with?

CRB: Probably 200, but I didn't have to manage them all directly. That's one of the issues of academic medicine: each faculty member is an independent entrepreneur. There were hundreds in the division, but I only had to manage the 20 faculty, my own laboratory (12 people), and a small number of staff.

WCR: You kept your own laboratory very active despite your directorship of the division?

CRB: We actually experienced considerable growth when I was there. Simultaneously, the work was becoming more and more interesting and the laboratory was growing. Within a few years, we had $1 million per year in grant funding. The responsibilities of running the division got to be pretty substantial, and at the same time the laboratory was getting bigger. Moreover, I became an associate director of the cancer center, and we got a “comprehensive” status for the center and got a cancer center building started. The challenge was how to keep all of that going. I had to work a little bit later and work weekends to do the boring administrative work that I couldn't get done during the week.

WCR: The amount of time you were spending at work in San Diego was no different than Ann Arbor?

CRB: Maybe a bit more.

WCR: How did the Baylor job come about?

CRB: A faculty member named Alan Hofmann is a collaborator and good friend of John Fordtran. One day John told him, “We're looking for a new chief of gastroenterology. The search committee has met and we've decided that instead of appointing an excellent clinician from within, we'd try to recruit a researcher through a national search and put some resources behind it. We have an endowed chair and will build a laboratory. The search committee decided to recruit a colon cancer researcher because it fits with the strengths of the hospital.” They already had successful colorectal surgery and gastroenterology programs. Also, colon cancer has been a very active area of research at the national and international level over the last 10 or 15 years. Alan told John, “Rick won't want this job, but he will surely know who all the potential candidates are.” Alan told me that John Fordtran would give me a call and ask me to come to BUMC and be a consultant for them. Alan said, “He'll probably ask you if you want the job, but essentially he just wants to know the names of others.” John called me and said he wanted me to help him. I flew to BUMC in October 2001 and I gave him my opinion on the subject, and I got to know BUMC for the first time. He showed me the lab space and I told him the names of some people. At dinner that night he said, “We thought maybe you might be interested in this job.” I said quite honestly that there was no chance that I would be interested in the job. They asked, “Why not?” I said, “Because I've got a perfectly good job in San Diego and, furthermore, my career is really in academic medicine.” I didn't think twice about it.

They invited me to come back in December for some meeting that was going on, and I couldn't make it. Later, Dan DeMarco and Dan Polter invited me to come to BUMC as the Milford Rouse lecturer. There was no discussion about the job. They also wanted me to discuss some cases with the housestaff having to do with hereditary colon cancer. I came and gave the medical grand rounds and met with the housestaff and we discussed some cases. We had lunch, and then I went to the Digestive Disease Center conference room, where the search committee was sitting and there were some architectural plans. I asked, “What's this all about?” John Fordtran said, “We thought that you might want the job.” I told them, “Really, there is no chance that I would leave San Diego.” John said, “I'll mail you the offer letter anyway, just so you can see it with your own eyes.” I said, “Just e-mail it to me.” I listened to what they had to say. On the way home I thought it would be nice to have all of my time dedicated to research. There was considerable appeal to that.

About the same time we got a new chairman of medicine at UCSD. He's a very good man; he's smart and I liked him very much. When he started, it was difficult for him to make decisions about moving resources around, and I thought that I had to make changes to keep the division healthy. I got a little frustrated about that and had a couple of meetings with him to work these issues out. About that time, John Fordtran e-mailed me the BUMC offer. I took a look at it and thought, “That sounds pretty interesting.” I also thought, “No, I don't think I could do it, and moreover, I could never talk my wife into moving to Dallas.” I sent John an e-mail back, “John, I looked at your offer and it's” “remotely possible—that I would make this move, but I doubt that I could ever get my wife to leave San Diego.” By some fluke (I don't know how it happened), not only did this message go to John Fordtran but somehow that note went to everyone in my lab. I had to go tell them, “No. No. No. I'm really not going to Dallas.” (Very embarrassing.) Then I had another meeting with the chairman of medicine and said, “BUMC is offering me an endowed chair to come and to do research all the time. I'm wondering whether I have the right job or not.” He told me, “No. You don't want to do that.” He had me meet with the dean. My wife was pretty resistant to leaving San Diego. The chairman said, “Look. I don't have a large endowed chair to give you. Otherwise, we could discuss that.”

The letter from John Fordtran made me reevaluate what I really wanted to do with the rest of my career (Figure 13). I was 55. Optimistically, I figured I had 10 or 15 years of real productivity left. I began to realize that if I wanted to carry through on the research I was doing, I should focus all my attention on it. To make a long story short, not only did I convince myself to come, I convinced my wife to move, which was the harder of the two. I said to the chairman of medicine, “Please get back to me on these 10 agenda items. I don't want to negotiate them one by one. If you can work it out, fine, but I'm going to think about this other job. I'm at the point where if I decide to make one more career move, that's what I'll do.” I'm sure he didn't think there was any chance I would go. People just didn't leave La Jolla. Before I left, I met with two key people in my laboratory, Jennifer Rhees and Ajay Goel. I told them, “I know that we've had a good run here in San Diego. What would you think if I had all my time to focus in the lab, and we had even more resources in addition to our grants?” They said it sounded pretty good. Both of them were concerned about buying a house and raising their families in San Diego. They both said that they would consider coming to Dallas. I was able to come to BUMC with my laboratory manager, Jennifer; my right-hand scientific colleague, Ajay; and a postdoctoral fellow, Kazu Kashiwagi.

Figure 13.

With his new friend and mentor in Dallas, John S. Fordtran, MD, 2004.

We were able to build up the lab all over again. Over the past year, I have gotten a new grant and a renewal of my existing grant with some of the best study section scores of my life.

WCR: Why is that? Because now you could focus far more of your time on research?

CRB: I think it's an issue of dedicated time and focus, but I've also been able to convince the study sections that I have the perfect situation by having a lot of patients getting their gastroenterology care and colon cancer operations here. I don't have to wait for collaboration with another group to get the proper materials. I've got everything that I need here at BUMC.

WCR: Are you doing any clinical work?

CRB: Yes, I am. Every week I see a couple of new families with hereditary colon cancer. Hereditary colon cancer is called Lynch syndrome from one of the articles I wrote in 1984. It is probably the most common form of all the hereditary cancers. Approximately 1 in 200 to 1 in 500 people carry a mutation of one of the genes for this disease. This means that there might be 10,000 such people in the extended Dallas—Fort Worth metroplex. A whole family of related genes can be mutated for this form of inherited cancer to occur. Some of them give a more striking clinical picture, like my father's family, and others give a weaker phenotype that might not even be recognized as such by most doctors. The most fulfilling thing I do is to give a family the information they need: if they follow a regimen of preventive treatment, they might get a cancer but they are not going to die of it. And to others in the family who fear that they carry this gene, I can tell them that they don't need to have all the intensive surveillance procedures. I'm happiest when I can relieve people of the anxiety that I've lived with for so long.

WCR: How much time do you spend now doing clinical work?

CRB: A half day a week in the clinic and some inpatient consults.

WCR: Has BUMC fulfilled all the promises it made to you?

CRB: Yes. It's not just BUMC. It's the surgeons, the pathologists, and the many others who have been cooperative and helpful. The colorectal surgeons have been really good. Richard Meyer, the pathologist, is very skilled at reading the colon cancers. He can now pick out the hereditary colon cancers before we even analyze the genes. He is a valued colleague.

WCR: Have you been surprised at the clinical excellence at Baylor?

CRB: No. I anticipated it. It's not a big secret that many of the excellent researchers in medical schools aren't necessarily up to date on everything in clinical medicine. I anticipated that I'd be going to an institution with greater traditions of clinical excellence than at the medical school. The problem with the medical school is that people are so distracted they don't have the time to really take care of the patients as well as they might. On the other hand, the challenge in community hospitals is to use their clinical resources to enhance research progress. That is an essential part of clinical excellence.

WCR: Do you miss academia?

CRB: No. I brought it with me. During my last 8 or 9 years at UCSD, I didn't have time to go to the conferences. I didn't have the leisurely life of the academic that some might imagine. I'm not sure where it exists. Academic medicine is neither threadbare nor genteel anymore; it's competitive, and you have to work hard. Through telephone and e-mail, I continue to collaborate with and get information from the same people as before. I didn't have enough of those face-to-face meetings with my scientific colleagues. Everybody is too busy. I have just as much contact with my academic colleagues as I ever did.

WCR: How has Dallas worked out for you and Pat?

CRB: It's a lot hotter than San Diego in the summer! I've really enjoyed Dallas. One surprise for me was how highly developed the arts community is in Dallas. The philanthropy is more highly developed and functional than in southern California. I'm a big fan of opera and the symphony. San Diego lost its symphony, and it's just being resuscitated. They had a good opera company, but they have a pretty good opera company here. The symphony in Dallas is spectacular. I guess I was surprised by the quality of the arts, and I like that.

WCR: I presume you still travel a good bit?

CRB: Probably too much.

WCR: How many trips do you go on a year?

CRB: I try to limit it to two trips a month, but it's sometimes three.

WCR: Are they mainly to give talks?

CRB: Always. It's usually for an invited lecture at a medical school or at a conference.

WCR: Do you like traveling?

CRB: I do, but not to the extent I'm doing now. Friends invite me or there's typically some reason why I can't refuse. I say no to a lot of travel, but there are too many interesting conferences and meetings. I was recently at a meeting with tumor biologists, like myself, and mathematicians. We had a 2-day discussion about mathematical modeling of tumor progression based upon known rates of mutation; we considered limitations on the rate of mutations, whether there could be too many mutations, and whether excessive mutations might be lethal to a tumor. There are some very interesting and predictable mathematical restraints on what a tumor can do. These may have some impact on how we should treat some cancers. Sometimes you must travel to start thinking in new directions.

WCR: You must like the fact that Dallas is a great city if you travel much. You can go almost anywhere relatively easily from Dallas.

CRB: The Dallas—Fort Worth airport is a major plus for Dallas.

WCR: What have your daughters done?

CRB: My oldest daughter, Tara, graduated from Bowdoin College in Maine as an English major. She started off in the business world working in New York City and was quite successful in what she was doing, but she wasn't happy that the people around her were too focused on making lots of money. After a couple of years, she became a high school teacher. She is now an English teacher in San Francisco, which she really enjoys. She feels more fulfilled now. She has used each summer to pursue a master's degree in English. She also coached field hockey and lacrosse teams at Miss Porter's School in Farmington, Connecticut, when she taught there. She is a multitalented young woman. She has a lot of ideas about how to teach English and writing. It will not surprise me if she becomes involved in teaching at a very broad leadership level some day.

My middle daughter, Maureen, initially had a job in San Francisco with one of the dot.com companies. Her friends all talked about waiting for the initial public offering to come in and becoming millionaires. She left this and became a social worker in the city. In the fall of 2003, she began getting her master's degree in public health at the University of North Carolina. After graduation she wants to go back to San Francisco, which she enjoyed so much. Maureen has a lot going for her. She is a talented scholar, is an excellent actress, and may have been the best athlete of the girls. She was the fastest sprinter on the girls—high school track team when she was a ninth grader—but she found track too boring. She is always ready for new adventures, and I would characterize her as a seeker and one who dreams of how things might be. She would like to make the world a better place.

My youngest daughter, Brigid, finished college in 2003, took a year off doing research at UCSF, and then applied to medical school. She was a cellular and molecular biology student at Yale University and did very well. She won some research grants and did research each summer. She is currently at the San Francisco VA Hospital, which is where I started my research career. She decided that she was interested in infectious diseases, and she wants to solve big problems, such as HIV and viral hepatitis. She'll start medical school at UCSF in September 2004 (Figure 14).

Figure 14.

Christmas family picture taken in La Jolla, 2002.

WCR: She sounds like you.

CRB: You don't want to get in this kid's way. She's got focus and discipline. All three girls were very good athletes, which is one way to foster focus and discipline (Figure 15). Brigid and Tara were 4-year varsity athletes in college and are still very active.

Figure 15.

Maureen, Tara, and Brigid showing their muscles in La Jolla, 1996.

WCR: In what sport?

CRB: Tara played field hockey and lacrosse, and Brigid stuck with field hockey. Maureen now loves rock climbing, which requires considerable strength and nerve.

WCR: You mentioned your love of music—opera and symphony. What other nonmedical hobbies do you have?

CRB: For one, I enjoy reading history. I find the history of science very interesting and also the history of politics and people. One of my favorite books from about 20 years ago is The Discovers by Daniel Boorstein. I just finished reading two books by Jim Watson (the DNA guy). I reread The Double Helix, which he wrote in the 1960s, and another that is subtitled After the Double Helix. I just read a book by Mike Bishop, who discovered oncogenes with Harold Varmus, called How to Win the Nobel Prize. (It turns out he doesn't really tell you how to do that.) When my daughter was taking a course on the Holocaust several years ago, I read The Rise and Fall of the Third Reich and a book called The History of the Jews. Having worked with a lot of Jewish colleagues over the years, I thought that was a very interesting book. Another book from many years back that is still fresh in my mind is The Rise and Fall of the Great Powers, by Paul Kennedy, which gives an economic analysis of why highly developed, dominant civilizations fail. At any given time I am usually reading a history book and a novel. I've read everything that John Irving has written. I love his storytelling. I read a number of books by Ann Rice about vampires and witches just to show I'm not entirely a science wonk. I loved those books also. I just finished reading Dan Brown's book, The Da Vinci Code, which was great fun.

WCR: Is Pat a reader? Does she read a lot?

CRB: Yes. She reads more than I do.

WCR: So you have a lot to talk about every day?

CRB: One of the nice things is that starting in about 1990 we began running an hour together every morning. I think that was a very healthy thing for our marriage. If you take your marriage for granted, then you are on the slippery slope.

WCR: Those who run together stay together.

CRB: Yes, because we don't run so fast that we can't talk. We talk the whole way. Moreover, you can't walk away in the middle of the conversation even if you disagree. There's no hurry, no distractions, no telephone, no beeper. Those are the best parts.

WCR: You made the right move coming to Dallas?

CRB: I think so. The one thing I didn't mention earlier, and this was a very important issue to me, I knew I would get to see more hereditary colon cancer patients in Dallas. Very few were referred to me in San Diego because the managed care system discouraged outside referrals. I get to see a lot of patients now, and that's been very rewarding.

Also, starting in the mid 1990s, we discovered that there is a transforming virus in colon cancer. I think this is going to be a very important thing, and it may be the next huge chapter in colon cancer. I've just gotten a grant from the NIH to study this. All of the data that we get tell me this is what triggers the start of colon cancer. It's an odd thing, but we began this line of research in January 1994, the same month we started our most important hereditary colon cancer models. We realized that the type of “pathway” involved in hereditary colon cancer was present in 15% of colon cancers; actually only a small portion of those are the hereditary types. Just to keep the lab honest, we started another project working on what the other 85% were all about.

I had a very fateful meeting with one of the many father figures I've had over the years. Henry Lynch was one of them, by the way. But the critical one was Jim Neel. We had a discussion in his office at the University of Michigan about what might cause the form of genomic instability that did not occur in hereditary colon cancer. He got me onto this idea that a transforming virus might do it. Neither of us knew anything about these viruses. I viewed the virus as a mobile oncogene. Instead of getting too worried about the complexity of the virus, I just looked at it as another gene that got tangled up in the colon. I used all the techniques I had learned over the preceding 3 years. We found that this virus is in 89% of colon cancers. In the lab, we can transform normal cells with this virus, and we all carry this virus in our gut. My desire to study this further wasn't the straw that broke the camel's back in terms of leaving San Diego; it was the 2×4.1 really wanted to explore this fully. I knew that the way things were going in San Diego I was going to be splitting my time between administrative duties and research. When it came down to it, I said, “You only live once. What is really important? What are you doing on this planet, and how can you do the most good?” It meant giving up the weather and beach in San Diego.

WCR: Is there anything that you would like to discuss that we haven't talked about?

CRB: I wish I'd said a little more about my wife (Figure 16). She's a wonderful person and the most important human in my life. She's often the beacon for me. If I ever get close to the side of the road, she keeps me straight. She's my moral compass. The relationship she has with our daughters is something to behold. Our daughters will confide anything and everything with her. I think my daughters are very well adjusted because of Pat. My daughters are also lively people. It's not that they've never explored or been adventurous in the world, but we haven't had any major problems. I attribute that completely to my wife. She is a very dedicated and hard-working pediatric nurse practitioner and had a job she loved in La Jolla, and she gave that up to move to Dallas with me. I owe her a lot for that sacrifice. She is an accomplished professional and she has accommodated the various moves the family has made over the years.

Figure 16.

Rick and Pat in Forest Lake, Pennsylvania, 2003.

WCR: You may be a modest man, but that's a very nice thing to say. I think this has been terrific. I'm glad that you are at BUMC.

Thanks for coming and thanks for being so open and sharing your soul, so to speak, with the readers of BUMC Proceedings.

CRB: There was a time when I could not talk about my father's illness openly. It was too sensitive for me. For years and years, I couldn't speak about the fact that my family had Lynch syndrome. It's only by getting involved in the research that I was able to tame the demon.

WCR: Many thanks, Rick.

CRB'S BEST PUBLICATIONS AS SELECTED BY HIM

(Publications are numbered according to his curriculum vitae.)